South Lake Primary Care P A
South Lake Primary Care P A provides Family Medicine Physician services in Mascotte, Florida. Licensed in Florida. Registered with an NPI since 2012.
- Licensed in
- FL
- In the registry since
- 2012
Practice location Address checks out
219 W Myers Blvd Ste CMascotte, FL 34753-9793 Not confirmed with CMS for 13 years — call before visiting
Phone: (352) 557-4840
Fax: (352) 557-4839
Show map & directions
Directions in Google Maps · Apple Maps · OpenStreetMap
Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Family Medicine Physician (primary) | Taxonomy 207Q00000X · Licence ME0071348 (FL) |
|---|
Record details
| NPI number | 1164783528 |
|---|---|
| Entity type | Organization (Type 2) |
| Organization subpart | No |
| Authorized official | Ramon Sueiro — Medical Director · (352) 557-4840 |
| NPI enumerated | June 1, 2012 |
| Last updated in NPPES | August 30, 2013 |
| Mailing address | 1503 Sunrise Plaza Dr, Clermont, FL 34714-6200 |