# SOUTH LAKE INTERNAL MEDICINE PA

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

## Provider details

- **NPI number:** 1801838313
- **Authorized official:** DR. JAMES M RAY (PRESIDENT)
- **Authorized official phone:** (352) 394-1969

## Contact information

- **Practice address:** 1371 CITRUS TOWER BLVD, CLERMONT, FL 34711-1924
- **Practice address phone:** (352) 243-2141
- **Practice address fax:** (352) 243-1309
- **Mailing address:** 1101 CITRUS TOWER BLVD, CLERMONT, FL 34711-1905
- **Mailing address phone:** (352) 243-2141
- **Mailing address fax:** (352) 243-1309

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2006
- **Last updated:** 09/18/2008