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General NPI Number Information
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NPI Number | 1073639969
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Entity Type | Organization
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Legal Business Name | MOUNT DORA FAMILY PRACTICE PA
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 18540 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6725
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Country | US
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Telephone | 352-383-7743
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Fax | 352-383-9226
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Provider Business Mailing Address
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Address Line | 18540 US HIGHWAY 441
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City | MOUNT DORA
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State | FL
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Zip | 32757-6725
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Country | US
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Telephone | 352-383-7743
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Fax | 352-383-9226
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT DALE LYNCH
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Credential | M.D.
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Telephone | 352-383-7743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME55532
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License Number State | FL
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