Basic Information
Provider Information
NPI: 1205809639
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHWARTZ
FirstName: PAMELA
MiddleName: DAWN
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 95004
Address2:  
City: LAKELAND
State: FL
PostalCode: 338045004
CountryCode: US
TelephoneNumber: 8636807206
FaxNumber: 8636807420
Practice Location
Address1: 2140 E COUNTY ROAD 540A
Address2:  
City: LAKELAND
State: FL
PostalCode: 338133740
CountryCode: US
TelephoneNumber: 8636472313
FaxNumber: 8636469414
Other Information
ProviderEnumerationDate: 02/08/2006
LastUpdateDate: 02/03/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/03/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XOS8613FLY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


Home