Provider Demographics
NPI:1447259106
Name:ICAZA, ORLANDO JOSE (MD)
Entity type:Individual
Prefix:DR
First Name:ORLANDO
Middle Name:JOSE
Last Name:ICAZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 100275
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-273-7839
Mailing Address - Fax:352-273-8172
Practice Address - Street 1:732 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4442
Practice Address - Country:US
Practice Address - Phone:352-265-8356
Practice Address - Fax:352-787-0854
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66190207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267636200Medicaid
FL71176OtherBCBS
P00208162OtherRAILROAD MEDICARE
E21117Medicare UPIN