Individual
GARY VISSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2940 MAGUIRE RD STE 200, OCOEE, FL 34761-4751
(407) 581-9065
(321) 348-5827
Mailing address
2940 MAGUIRE RD STE 200, OCOEE, FL 34761-4751
(407) 581-9065
(321) 348-5827
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
ME105459
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME105459
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
O5086
HF MEDICARE
FL
Enumeration date
08/24/2007
Last updated
04/05/2022
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