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General NPI Number Information
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NPI Number | 1619734829
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Entity Type | Organization
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Legal Business Name | JWLEX, LLC
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 410 S 11TH ST
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City | LAKE WALES
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State | FL
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Zip | 33853-4203
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Country | US
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Telephone | 917-880-2083
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Fax |
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Provider Business Mailing Address
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Address Line | 146 MIRAMAR RD
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City | LAKELAND
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State | FL
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Zip | 33803-2630
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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 | MANAGING MEMBER
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Name | JANEY WONG
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Credential | DO
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Telephone | 917-880-2083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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