Organization
SPORTS MEDICINE INSTITUTE INTERNATIONAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEE LEIANN RAY RN (PRESIDENT)
(352) 243-9700
Entity
Organization
Contact information
Practice address
1925 DON WICKHAM DR, CLERMONT, FL 34711-1915
(352) 243-9700
(352) 243-5795
Mailing address
1925 DON WICKHAM DR, CLERMONT, FL 34711-1915
(352) 243-9700
(352) 243-5795
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME0037707
FL
Other
Enumeration date
07/17/2013
Last updated
12/10/2013
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