Organization
TRICOUNTY SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM S MAXFIELD MD (MEDICAL DIRECTOR)
(352) 240-1146
Entity
Organization
Contact information
Practice address
510 CR 466, SUITE 207, LADY LAKE, FL 32159
(352) 240-1146
Mailing address
510 CR 466, SUITE 207, LADY LAKE, FL 32159
(352) 240-1146
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
ME15266
FL
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
ME52212
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ME15266
NPI 1134186935
FL
Enumeration date
02/21/2013
Last updated
04/26/2013
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