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General NPI Number Information
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NPI Number | 1407210750
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Entity Type | Organization
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Legal Business Name | LAB DOCTOR
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 1425 SE 17TH ST STE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1727
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Country | US
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Telephone | 954-530-4447
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 SE 17TH ST STE A
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1727
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | IWONA M PIKOR
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Credential |
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Telephone | 854-822-6331
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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 | ME52542
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License Number State | FL
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