| South Lake Primary Care P A | |
|
219 W Myers Blvd Suite C Mascotte FL 34753-9793 | |
| (352) 557-4840 | |
| (352) 557-4839 |
| Full Name | South Lake Primary Care P A |
|---|---|
| Speciality | Family Medicine |
| Location | 219 W Myers Blvd, Mascotte, Florida |
| Authorized Official Name and Position | Ramon Sueiro (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3525574840 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Lake Primary Care P A 1503 Sunrise Plaza Dr Clermont FL 34714-6200 Ph: (352) 243-3800 | South Lake Primary Care P A 219 W Myers Blvd Suite C Mascotte FL 34753-9793 Ph: (352) 557-4840 |
| NPI Number | 1164783528 |
|---|---|
| Provider Enumeration Date | 06/01/2012 |
| Last Update Date | 08/30/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164783528 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | ME0071348 (Florida) | Primary |
Clark Clinic Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 910 W Myers Blvd, Mascotte, FL 34753 Phone: 352-787-1600 Fax: 352-793-3282 | |
Lowell F Clark Md Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 910 W Myers Blvd, Mascotte, FL 34753 Phone: 352-557-8700 |