Basic Information
| Provider Information | |||||||||
| NPI: | 1699219113 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKEWOOD RANCH PRIMARY CARE ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6101 WEBB RD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336152872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132696426 | ||||||||
| FaxNumber: | 8133425261 | ||||||||
| Practice Location | |||||||||
| Address1: | 822 62ND STREET CIR E | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342086208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9412433983 | ||||||||
| FaxNumber: | 9418963795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2016 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| AuthorizedOfficialLastName: | PULCINI | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 8132696426 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME83175 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.