Healthcare Provider Details

I. General information

NPI: 1932180239
Provider Name (Legal Business Name): PAMELA J LETTS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 GULF OF MEXICO DR
LONGBOAT KEY FL
34228-2070
US

IV. Provider business mailing address

3888 LYNDHURST CT
SARASOTA FL
34235-2421
US

V. Phone/Fax

Practice location:
  • Phone: 941-387-1211
  • Fax: 941-387-1220
Mailing address:
  • Phone: 941-387-1211
  • Fax: 941-387-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME66227
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: