Organization
GOOD SHEPHERD MEDICAL CLINIC PA
Active
Organization
GOOD SHEPHERD MEDICAL CLINIC PA
Active
Parent organization
GOOD SHEPHERD MEDICAL CLINIC PA
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD MEDICAL CLINIC PA
Authorized official
DR. ROGER B LEE M.D. (PRESIDENT)
(352) 686-5023
Entity
Organization
Contact information
Practice address
11373 CORTEZ BLVD, SUITE 209, BROOKSVILLE, FL 34613-5414
(352) 596-4027
(352) 597-9727
Mailing address
11373 CORTEZ BLVD, SUITE 209, BROOKSVILLE, FL 34613-5414
(352) 596-4027
(352) 597-9727
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0048810
FL
Other
Enumeration date
04/20/2009
Last updated
04/20/2009
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