MEDICARE: PRIMARY CARE DR Z PPLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1740885938
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY CARE DR Z PPLC

Provider Business Mailing Address
First Line	:	38732 LAKEVIEW WALK
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-6046
Country	:	US
Telephone Number	:	305-469-8288
Fax Number	:

Provider Business Practice Location Address
First Line	:	38732 LAKEVIEW WALK
Second Line	:
City	:	LADY LAKE
State	:	FL
Zip	:	32159-6046
Country	:	US
Telephone Number	:	305-469-8288
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MARTHA ESPINAL
Credential	:
Telephone Number	:	352-661-8593

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/03/2020

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