Organization
LAKE MARY FAMILY PHYSICIANS P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LEAH M SUTPHIN (BILLING MANAGER)
(407) 829-8960
Entity
Organization
Contact information
Practice address
910 WILLISTON PARK PT, SUITE 2050, LAKE MARY, FL 32746-2172
(407) 829-8960
(407) 829-8978
Mailing address
910 WILLISTON PARK PT, SUITE 2050, LAKE MARY, FL 32746-2172
(407) 829-8960
(407) 829-8978
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
ME88467, ME88578
FL
363L00000X
Nurse Practitioner
ARNP1103432
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
94986
BCBS OF FLORIDA
FL
01
—
K8696
MEDICARE GROUP NUMBER
FL
Enumeration date
09/25/2007
Last updated
07/07/2009
Update your record
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