Organization
CENTRAL FLORIDA PHYSICIAN NETWORK LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN MARK RODKEY (VP)
(850) 523-2117
Entity
Organization
Contact information
Practice address
200 N MANGOUSTINE AVE, SANFORD, FL 32771-1017
(407) 833-7415
(407) 833-7416
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 372-5426
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000354800
—
FL
01
—
35926
BCBS-FL
FL
01
—
D03210
RR MEDICARE
FL
Enumeration date
05/07/2008
Last updated
01/16/2018
Update your record
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