Organization
CITRUS CHEST AND LUNG SPEC PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GWENDOLYN L PIAZZA (OFFICE MANAGER)
(352) 637-5678
Entity
Organization
Contact information
Practice address
318 SOUTH LINE AVE, INVERNESS, FL 34452-4606
(352) 637-5678
(352) 344-3569
Mailing address
318 SOUTH LINE AVE, INVERNESS, FL 34452-4606
(352) 637-5678
(352) 344-3569
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME0052185
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
063377100
—
FL
01
—
680101
BCBS PENN
PA
01
—
72420
BC BS GROUP NUMBER
FL
01
—
FEDERAL BLACK LUNG
029478100
FL
Enumeration date
08/29/2006
Last updated
06/30/2010
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