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 MD (PRESIDENT)
(352) 686-5023
Entity
Organization
Contact information
Practice address
11329 CORTEZ BLVD, BROOKSVILLE, FL 34613
(352) 596-5052
(352) 596-5244
Mailing address
11329 CORTEZ BLVD, BROOKSVILLE, FL 34613-5407
(352) 596-5052
(352) 596-5244
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME46566
FL
Other
Enumeration date
06/04/2008
Last updated
06/25/2008
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