| Entity Name: | FLORIDA SURGICAL GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 01 Feb 1977 (48 years ago) |
| Document Number: | 523899 |
| FEI/EIN Number | 591713370 |
| Address: | 661 E. ALTAMONTE DR., #323, ALTAMONTE SPRGS, FL, 32701 |
| Mail Address: | 661 E. ALTAMONTE DR., #323, ALTAMONTE SPRGS, FL, 32701 |
| ZIP code: | 32701 |
| County: | Seminole |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1710977251 | 2005-10-26 | 2010-01-21 | 661 E ALTAMONTE DR, SUITE 323, ALTAMONTE SPRINGS, FL, 327015105, US | 661 E ALTAMONTE DR, SUITE 323, ALTAMONTE SPRINGS, FL, 327015105, US | |||||||||||||||||||||||
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| Phone | +1 407-834-6965 |
| Fax | 4078340424 |
Authorized person
| Name | DR. JEFFERY RAY CRYAR |
| Role | PRESIDENT |
| Phone | 4078346965 |
Taxonomy
| Taxonomy Code | 208600000X - Surgery Physician |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 370052600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CRYAR JEFFERY R | Agent | 661 E. ALTAMONTE DR., ALTAMONTE SPRGS, FL, 32701 |
| Name | Role | Address |
|---|---|---|
| CRYAR JEFFERY R | President | 661 E. ALTAMONTE DR. #323, ALTAMONTE SPRINGS, FL, 32701 |
| Name | Role | Address |
|---|---|---|
| CRYAR JEFFERY R | Director | 661 E. ALTAMONTE DR. #323, ALTAMONTE SPRINGS, FL, 32701 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 1987-10-05 | FLORIDA SURGICAL GROUP, P.A. | No data |
| NAME CHANGE AMENDMENT | 1978-08-16 | GERSCOVICH & ULCH, M.D., P.A. | No data |
Date of last update: 03 Jan 2025
Sources: Florida Department of State
