Healthcare Provider Details

I. General information

NPI: 1003661521
Provider Name (Legal Business Name): LAWRENCE MATEO ANACAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2024
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6325 US HIGHWAY 27 N STE 201
SEBRING FL
33870-8226
US

IV. Provider business mailing address

6325 US HIGHWAY 27 N STE 201
SEBRING FL
33870-8226
US

V. Phone/Fax

Practice location:
  • Phone: 863-402-3411
  • Fax:
Mailing address:
  • Phone: 863-273-9945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN39244
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: