# LAKE WOMEN FOR WOMEN OB/GYN,LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043585169
- **Authorized official:** DR. MAMIE ROGERS MD (OWNER)
- **Authorized official phone:** (352) 589-6005

## Contact information

- **Practice address:** 2 N EUSTIS ST, EUSTIS, FL 32726-3408
- **Practice address phone:** (352) 589-6005
- **Practice address fax:** (352) 484-0189
- **Mailing address:** PO BOX 780, TAVARES, FL 32778-0780
- **Mailing address phone:** (352) 589-6005
- **Mailing address fax:** (352) 484-0189

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/22/2012
- **Last updated:** 03/22/2012