Provider Demographics
NPI:1902094725
Name:GFM FAMILY MEDICINE
Entity Type:Organization
Organization Name:GFM FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMENDOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-275-0080
Mailing Address - Street 1:5575 S SEMORAN BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-1747
Mailing Address - Country:US
Mailing Address - Phone:407-275-0080
Mailing Address - Fax:407-275-8775
Practice Address - Street 1:5575 S SEMORAN BLVD
Practice Address - Street 2:SUITE 23
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-1747
Practice Address - Country:US
Practice Address - Phone:407-275-0080
Practice Address - Fax:407-275-8775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28143OtherBLUE CROSS BLUE SHIELD
FLBD4403161OtherD.E.A. NUMBER
FL51801387OtherAETNA PROVIDER NUMBER
FLME61279OtherFLORIDA STATE LICENSE
FLME61279OtherFLORIDA STATE LICENSE