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Organization
SOUTH LAKE INTERNAL MEDICINE PA
Active
Organization
SOUTH LAKE INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES M RAY (PRESIDENT)
(352) 394-1969
Entity
Organization
Contact information
Practice address
1371 CITRUS TOWER BLVD, CLERMONT, FL 34711-1924
(352) 243-2141
(352) 243-1309
Mailing address
1101 CITRUS TOWER BLVD, CLERMONT, FL 34711-1905
(352) 243-2141
(352) 243-1309
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
NULL
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Enumeration date
06/11/2006
Last updated
09/18/2008
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