Organization
DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LOWRANCE (ADMINISTRATOR)
(813) 839-3438
Entity
Organization
Contact information
Practice address
3345 S DALE MABRY HWY, TAMPA, FL 33629-7817
(813) 839-3438
Mailing address
3345 S DALE MABRY HWY, TAMPA, FL 33629-7817
(813) 839-3438
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L652453703740
DRIVERS LIC
FL
Enumeration date
01/25/2018
Last updated
01/25/2018
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