Provider Demographics
NPI:1114579158
Name:DOCTORS DIET PROGRAM OF SOUTH FLORIDA PLLC
Entity Type:Organization
Organization Name:DOCTORS DIET PROGRAM OF SOUTH FLORIDA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF CLINIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-957-6281
Mailing Address - Street 1:3345 S DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7817
Mailing Address - Country:US
Mailing Address - Phone:813-839-3438
Mailing Address - Fax:813-280-2258
Practice Address - Street 1:1501 W REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-4707
Practice Address - Country:US
Practice Address - Phone:813-519-3438
Practice Address - Fax:813-280-2258
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTORS DIET PROGRAM OF SOUTH FLORIDA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy