Healthcare Provider Details

I. General information

NPI: 1073565909
Provider Name (Legal Business Name): DIAGNOSTIC OUTPATIENT CENTERS II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 DOCTORS CT
LEESBURG FL
34748-7314
US

IV. Provider business mailing address

704 DOCTORS CT
LEESBURG FL
34748-7314
US

V. Phone/Fax

Practice location:
  • Phone: 352-314-9333
  • Fax: 352-314-9334
Mailing address:
  • Phone: 352-314-9333
  • Fax: 352-314-9334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. LARRY J WILLIAMS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 727-896-2202