Healthcare Provider Details

I. General information

NPI: 1093889529
Provider Name (Legal Business Name): JERILEE EMMA LOMAS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 03/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BUSINESS WAY SUITE 2
LEHIGH ACRES FL
33936
US

IV. Provider business mailing address

1220 BUSINESS WAY SUITE 2
LEHIGH ACRES FL
33936-6073
US

V. Phone/Fax

Practice location:
  • Phone: 239-303-2600
  • Fax: 239-303-2604
Mailing address:
  • Phone: 239-303-2600
  • Fax: 239-303-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS7648
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: