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General NPI Number Information
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NPI Number | 1437451887
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Entity Type | Organization
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Legal Business Name | LAKE MARY MEDICAL CENTER
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 3629 LAKE EMMA RD
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City | LAKE MARY
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State | FL
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Zip | 32746-6199
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Country | US
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Telephone | 407-333-7995
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Fax | 407-333-7996
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Provider Business Mailing Address
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Address Line | 3629 LAKE EMMA RD
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City | LAKE MARY
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State | FL
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Zip | 32746-6199
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Country | US
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Telephone | 407-333-7995
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Fax | 407-333-7996
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MRS. MARY HARRISON
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Credential |
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Telephone | 407-333-7995
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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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