Provider Demographics
NPI:1447378054
Name:WINDERMERE ALLERGY & ASTHMA,INC
Entity type:Organization
Organization Name:WINDERMERE ALLERGY & ASTHMA,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROUSSARD-PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-876-1009
Mailing Address - Street 1:8946 CONROY WINDERMERE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3128
Mailing Address - Country:US
Mailing Address - Phone:407-876-1009
Mailing Address - Fax:407-876-6742
Practice Address - Street 1:8946 CONROY WINDERMERE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3128
Practice Address - Country:US
Practice Address - Phone:407-876-1009
Practice Address - Fax:407-876-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68693207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27553YMedicare ID - Type UnspecifiedMEDICARE PART B