Organization Name: | LEMON BAY PHYSICIANS, P.A. |
NPI Number: | 1275570517 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHEN LOGAN (PRESIDENT) |
Mailing Address: | 1885 Englewood Rd Englewood |
State: | FL US |
Postal Code: | 342231822 |
Phone Number: | 9414758291 |
Fax Number: | 9414733609 |
NPI Enumeration Date: | 06/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |