Organization
SOUTHSIDE MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROGER DAVID SUARES M.D. (MEDICAL DIRECTOR)
(863) 688-9219
Entity
Organization
Contact information
Practice address
1707 E EDGEWOOD DR, LAKELAND, FL 33803-3470
(863) 688-9219
(863) 687-4863
Mailing address
1707 E EDGEWOOD DR, LAKELAND, FL 33803-3470
(863) 688-9219
(863) 687-4863
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME0043239
FL
Other
Enumeration date
02/21/2013
Last updated
02/21/2013
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