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General NPI Number Information
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NPI Number | 1861499097
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Entity Type | Individual
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Provider Name | LAURIE J ANGLIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 03/17/2010
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Provider Practice Location Address
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Address Line | 403 VONDERBURG DR STE 101
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City | BRANDON
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State | FL
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Zip | 33511-5982
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Country | US
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Telephone | 813-681-1122
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Fax | 813-684-4924
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Provider Business Mailing Address
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Address Line | 403 VONDERBURG DR STE 101
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City | BRANDON
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State | FL
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Zip | 33511-5982
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Country | US
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Telephone | 813-681-1122
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Fax | 813-684-4924
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME0037579
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License Number State | FL
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