South Lake Primary Care P a

NPI #1164783528 in Mascotte, Florida

Provider Information

NPI Number: 1164783528
Entity Type: Organization
Organization Name: South Lake Primary Care P a
Primary Specialty: Family Medicine
Enumeration Date: Jun 1, 2012
Last Updated: Aug 30, 2013

Practice Location

Address: 219 W MYERS BLVD
Address 2: SUITE C
City: Mascotte
State: Florida
ZIP Code: 34753-9793
Phone: (352) 557-4840

Authorized Official

Name: RAMON SUEIRO, MD
Title: MEDICAL DIRECTOR
Phone: (352) 557-4840

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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