Healthcare Provider Details

I. General information

NPI: 1073532198
Provider Name (Legal Business Name): LENA A GEORGES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 01/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 W SWANN AVE
TAMPA FL
33609-4039
US

IV. Provider business mailing address

2605 W SWANN AVE
TAMPA FL
33609-4039
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-7073
  • Fax: 813-879-3737
Mailing address:
  • Phone: 813-876-7073
  • Fax: 813-879-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO3086
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO3086
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: