Provider Demographics
NPI:1184760506
Name:OB & GYN SPECIALISTS, P.A.
Entity type:Organization
Organization Name:OB & GYN SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:MERVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-5371
Mailing Address - Street 1:1551 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-5499
Mailing Address - Country:US
Mailing Address - Phone:407-644-5371
Mailing Address - Fax:407-644-1417
Practice Address - Street 1:1551 CLAY ST
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-5499
Practice Address - Country:US
Practice Address - Phone:407-644-5371
Practice Address - Fax:407-644-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0030235207V00000X
FLME0030722207V00000X
FLME0043553207V00000X
FLME0049918207V00000X
FLME0063738207V00000X
FLME0064647207V00000X
FLME0062994207V00000X
FLME0067143207V00000X
FLME0071558207V00000X
FLME0086331207V00000X
FLME99195207V00000X
FLME100440207V00000X
FLME0083622207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty