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Organization

SILVER WINGS INDEPENDENCE AT HOME LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAURENCE MILTON PETTY M.D. (PHYSICIAN)
(727) 548-1232
Entity
Organization

Contact information

Practice address
6279 PARK BLVD N, PINELLAS PARK, FL 33781-3239
(727) 548-1232
(727) 548-1182
Mailing address
6279 PARK BLVD N, PINELLAS PARK, FL 33781-3239
(727) 548-1232
(727) 548-1182

Taxonomy

Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
ME68819
FL

Other

Enumeration date
02/09/2012
Last updated
02/09/2012
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