| Organization Name: | FLORIDA RADIOLOGY OF LAKE MARY, LLC |
| NPI Number: | 1003208620 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WARREN WYLIE (VP RADIOLOGY ENTERPRISE) |
| Mailing Address: | 9975 Tavistock Lakes Blvd Suite 120 Orlando |
| State: | FL US |
| Postal Code: | 328277559 |
| Phone Number: | 4072002865 |
| Fax Number: | |
| NPI Enumeration Date: | 02/19/2015 |
| NPI Last Update Date: | 02/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085R0202X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Radiology |
| Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |