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General NPI Number Information
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NPI Number | 1356530091
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Entity Type | Organization
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Legal Business Name | RADIOLOGY CONSULTANTS PA
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 130 BATES AVE SW
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City | WINTER HAVEN
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State | FL
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Zip | 33880-2953
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Country | US
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Telephone | 863-293-1071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2317
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City | WINTER HAVEN
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State | FL
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Zip | 33883-2317
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Country | US
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Telephone | 863-293-1071
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Fax |
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Authorized Official
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Title or Position | ASSISTANT ADMINISTRATOR
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Name | DEANNA LEPERE
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Credential |
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Telephone | 863-293-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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