Organization
GFM FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD AMENDOLA (BILLING MANAGER)
(407) 275-0080
Entity
Organization
Contact information
Practice address
5575 S SEMORAN BLVD, SUITE 23, ORLANDO, FL 32822-1747
(407) 275-0080
(407) 275-8775
Mailing address
5575 S SEMORAN BLVD, SUITE 23, ORLANDO, FL 32822-1747
(407) 275-0080
(407) 275-8775
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28143
BLUE CROSS BLUE SHIELD
FL
01
—
51801387
AETNA PROVIDER NUMBER
FL
01
—
BD4403161
D.E.A. NUMBER
FL
01
—
ME61279
FLORIDA STATE LICENSE
FL
Enumeration date
10/05/2007
Last updated
02/14/2008
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