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General NPI Number Information
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NPI Number | 1316303639
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Entity Type | Organization
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Legal Business Name | LOVELY PHYSICIAN CARE CORP
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 3300 TAMIAMI TRL UNIT 102
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8054
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Country | US
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Telephone | 941-889-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 TAMIAMI TRL UNIT 102
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-8054
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Country | US
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Telephone | 941-889-9525
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PIERRE LEROUX
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Credential | MD
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Telephone | 941-889-9525
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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 |
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License Number State |
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