Provider Demographics
NPI:1164827010
Name:OB/GYN ULTRASOUND, LLC
Entity type:Organization
Organization Name:OB/GYN ULTRASOUND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:FERNANCO
Authorized Official - Last Name:TOBON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACOG
Authorized Official - Phone:407-492-5931
Mailing Address - Street 1:5800 S SEMORAN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-4811
Mailing Address - Country:US
Mailing Address - Phone:407-270-5925
Mailing Address - Fax:407-205-1494
Practice Address - Street 1:5800 S SEMORAN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-4811
Practice Address - Country:US
Practice Address - Phone:407-270-5925
Practice Address - Fax:407-205-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1203132471S1302X
FLME98764207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008C7OtherBCBS