Organization
ERIC LUP-SING LO M. D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YVETTE S ANDERSON (CONSULTING MANAGER)
(386) 316-0955
Entity
Organization
Contact information
Practice address
305 MEMORIAL MEDICAL PKWY, DAYTONA BEACH, FL 32117-5168
(386) 672-1023
(386) 263-2996
Mailing address
305 MEMORIAL MEDICAL PKWY, DAYTONA BEACH, FL 32117-5168
(386) 672-1023
(386) 263-2996
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8346100
—
FL
Enumeration date
08/18/2017
Last updated
07/21/2022
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