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General NPI Number Information
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NPI Number | 1285611210
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF LAKE COUNTY, P.A.
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 04/02/2015
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Provider Practice Location Address
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Address Line | 619 W DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-2602
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Country | US
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Telephone | 352-314-2424
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Fax | 352-314-3010
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Provider Business Mailing Address
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Address Line | 619 W DIXIE AVE
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City | LEESBURG
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State | FL
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Zip | 34748-2602
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Country | US
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Telephone | 352-314-2424
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Fax | 352-314-3010
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY MARK BROWN
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Credential | M.D.
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Telephone | 352-314-2424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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