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General NPI Number Information
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NPI Number | 1386316602
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Entity Type | Organization
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Legal Business Name | FLORIDA RADIOLOGY IMAGING AT LAKE MARY, LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 1919 E HIGHWAY 50 STE 101
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City | CLERMONT
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State | FL
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Zip | 34711-1975
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Country | US
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Telephone | 352-717-3738
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Fax | 352-717-3739
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Provider Business Mailing Address
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Address Line | 235 E PRINCETON ST STE 100
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City | ORLANDO
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State | FL
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Zip | 32804-5554
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Country | US
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Telephone | 407-303-1414
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MICHAEL MAZERES
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Credential |
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Telephone | 407-357-1912
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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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