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Organization

EAST LAKE PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MELISSA MARIE MONTGOMERY (MANAGER)
(727) 372-6760
Entity
Organization

Contact information

Practice address
2137 LITTLE RD, TRINITY, FL 34655-4410
(727) 372-6760
(727) 372-6808
Mailing address
2137 LITTLE RD, TRINITY, FL 34655-4410
(727) 372-6760
(727) 372-6808

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME86866
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OS9496
LICENSE NUMBER
FL
Enumeration date
04/09/2007
Last updated
02/14/2024
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