| Lwr Family Practice Walk-in Pl | |
|
10910 E State Road 70 Suite 102 Lakewood Ranch FL 34202-8406 | |
| (941) 896-3900 | |
| (941) 896-3901 |
| Full Name | Lwr Family Practice Walk-in Pl |
|---|---|
| Speciality | Family Medicine |
| Location | 10910 E State Road 70, Lakewood Ranch, Florida |
| Authorized Official Name and Position | Mary J Mott (OWNER) |
| Authorized Official Contact | 9418963900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lwr Family Practice Walk-in Pl 10910 E State Road 70 Suite 102 Lakewood Ranch FL 34202-8406 Ph: (941) 896-3900 | Lwr Family Practice Walk-in Pl 10910 E State Road 70 Suite 102 Lakewood Ranch FL 34202-8406 Ph: (941) 896-3900 |
| NPI Number | 1639496540 |
|---|---|
| Provider Enumeration Date | 05/02/2010 |
| Last Update Date | 05/02/2010 |
| Medicare PECOS PAC ID | 8820282288 |
|---|---|
| Medicare Enrollment ID | O20101029000327 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639496540 | NPI | - | NPPES |
| PA9101315 | Other | FL | FLORIDA LICENSE NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | PA9101315 (Florida) | Primary |
| Provider Name | Oscar Espinosa |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1194732792 PECOS PAC ID: 1951399377 Enrollment ID: I20040504001382 |
| Provider Name | Diego Fallon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1932174794 PECOS PAC ID: 5092711937 Enrollment ID: I20110315001082 |
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