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General NPI Number Information
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NPI Number | 1427429281
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Entity Type | Organization
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Legal Business Name | LAKELAND PHYSICIANS & ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 01/19/2017
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Provider Practice Location Address
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Address Line | 1818 HARDEN BLVD STE 120
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City | LAKELAND
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State | FL
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Zip | 33803-1812
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Country | US
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Telephone | 863-210-5640
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Fax | 863-210-5716
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Provider Business Mailing Address
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Address Line | PO BOX 470426
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City | LAKE MONROE
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State | FL
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Zip | 32747-0426
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Country | US
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Telephone | 863-210-5640
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JEAN THOMAS
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Credential |
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Telephone | 863-210-5640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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