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Organization
LAKE CANCER MEDICAL CENTER PA
Active
Organization
LAKE CANCER MEDICAL CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LOURDES M MATHEW MD (MD)
(352) 728-2532
Entity
Organization
Contact information
Practice address
732 NORTH THIRD STREET, LEESBURG, FL 34748
(352) 728-2532
(352) 728-3004
Mailing address
732 NORTH THIRD STREET, LEESBURG, FL 34748
(352) 728-2532
(352) 728-3004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
ME81152
FL
207RH0003X
Hematology & Oncology Physician
ME24875
FL
207RH0003X
Hematology & Oncology Physician
Primary
ME80262
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94872
BCBS
FL
01
—
DE5747
RAILROAD MEDICARE
FL
Enumeration date
07/07/2006
Last updated
08/22/2011
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