Organization Name: | JACK LUND DO PA |
NPI Number: | 1417148503 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JACK R LUND (OWNER) |
Mailing Address: | 6545 Ridge Rd Ste 1 Port Richey |
State: | FL US |
Postal Code: | 346686865 |
Phone Number: | 7278438688 |
Fax Number: | 7278418300 |
NPI Enumeration Date: | 08/05/2007 |
NPI Last Update Date: | 08/05/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | OS 0001626 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |