Organization
PHYSICIANS IMAGING-MT DORA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELIAS J GERTH M.D. (OPERATING MANAGER)
(305) 295-1242
Entity
Organization
Contact information
Practice address
3615 LAKE CENTER DR, MOUNT DORA, FL 32757-2364
(352) 383-3716
(352) 383-7457
Mailing address
P.O. BOX 4610, LAKE CHARLES, LA 70606-4610
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
04/18/2007
Last updated
12/19/2007
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