Organization
LAKE WALES UROLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WILLIAM LOUGHLIN MD (PRESIDENT)
(863) 877-2411
Entity
Organization
Contact information
Practice address
1110 DRUID CIR, LAKE WALES, FL 33853-4307
(863) 877-2411
(863) 877-2377
Mailing address
1110 DRUID CIR, LAKE WALES, FL 33853-4307
(863) 877-2411
(863) 877-2377
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
ME87080
FL
Other
Enumeration date
10/02/2013
Last updated
10/04/2013
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