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General NPI Number Information
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NPI Number | 1639372634
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Entity Type | Organization
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Legal Business Name | EAR, NOSE & THROAT ASSOCIATES OF LAKE COUNTY , PA
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 2038 CLASSIQUE LANE
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 352-742-0225
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Fax | 352-742-0228
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Provider Business Mailing Address
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Address Line | 2038 CLASSIQUE LANE
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City | TAVARES
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State | FL
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Zip | 32778
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Country | US
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Telephone | 352-742-0225
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Fax | 352-742-0228
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Authorized Official
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Title or Position | DOCTOR
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Name | DON S. BURGOS
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Credential | MD
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Telephone | 352-742-0225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME0054256
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License Number State | FL
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