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General NPI Number Information
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NPI Number | 1992414684
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Entity Type | Organization
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Legal Business Name | BODY BY BARIATRICS, LLC
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 3030 HARDEN BLVD BLDG 1
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City | LAKELAND
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State | FL
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Zip | 33803-7952
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Country | US
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Telephone | 304-374-3584
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Fax |
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Provider Business Mailing Address
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Address Line | 7512 DR PHILLIPS BLVD STE 50-792
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City | ORLANDO
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State | FL
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Zip | 32819-5420
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Country | US
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Telephone | 304-374-3584
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Fax |
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Authorized Official
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Title or Position | CEO/BARIATRIC SURGEON
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Name | DR. ELIZABETH ANNE DOVEC
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Credential | MD
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Telephone | 304-374-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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