Healthcare Provider Details

I. General information

NPI: 1881642965
Provider Name (Legal Business Name): PULMONARY AND SLEEP CENTER OF LAKE CITY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/16/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NW TURNER AVE
LAKE CITY FL
32055-8306
US

IV. Provider business mailing address

320 NW TURNER AVE
LAKE CITY FL
32055-8306
US

V. Phone/Fax

Practice location:
  • Phone: 386-754-1711
  • Fax: 386-754-1712
Mailing address:
  • Phone: 386-754-1711
  • Fax: 386-754-1712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME87814
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME87814
License Number StateFL

VIII. Authorized Official

Name: DR. DIOGENES FRANSISCO DUARTE
Title or Position: PRESIDENT
Credential: MD
Phone: 386-754-1711