Organization
ORLANDO PHYSICIAN SPECIALISTS, LLC
Active
Other names
Urology Consultants
Organization subpart
No
Provider details
NPI number
Authorized official
ELIAS JACOBO M.D. (PRESIDENT)
(407) 332-0777
Entity
Organization
Contact information
Practice address
1561 W. FAIRBANKS AVE, WINTER PARK, FL 32789
(407) 478-4920
(407) 332-8767
Mailing address
PO BOX 11984, MSC 315, BIRMINGHAM, AL 35202-1984
(407) 478-4920
(904) 345-5841
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0027J
BCBS
FL
Enumeration date
01/06/2012
Last updated
11/25/2014
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