Healthcare Provider Details

I. General information

NPI: 1588799415
Provider Name (Legal Business Name): LAWRENCE ELLIS PARRISH DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 STATE ROAD 100
KEYSTONE HEIGHTS FL
32656-7653
US

IV. Provider business mailing address

7344 STATE ROAD 100
KEYSTONE HEIGHTS FL
32656-7653
US

V. Phone/Fax

Practice location:
  • Phone: 352-473-4966
  • Fax:
Mailing address:
  • Phone: 352-473-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVM1585
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: