Organization
MEDERO MEDICAL OF LAKE, LLC
Active
Other names
Medero Medical Lake
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LARRY MAYFIELD (ADMINISTRATOR)
(352) 629-3433
Entity
Organization
Contact information
Practice address
1109 SW 10TH ST, OCALA, FL 34471-0325
(352) 629-3433
(352) 629-6796
Mailing address
312 S LAKE ST, LEESBURG, FL 34748-5934
(352) 629-3433
(352) 629-6796
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
12664
FL
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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