Provider Demographics
NPI:1326078056
Name:PAMELA J. LETTS, MD PA
Entity Type:Organization
Organization Name:PAMELA J. LETTS, MD PA
Other - Org Name:CENTRE SHOPS FAMILY PRACTICE AND URGENT CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-387-1211
Mailing Address - Street 1:3888 LYNDHURST CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2421
Mailing Address - Country:US
Mailing Address - Phone:941-387-1211
Mailing Address - Fax:941-387-1220
Practice Address - Street 1:5370 GULF OF MEXICO DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228
Practice Address - Country:US
Practice Address - Phone:941-387-1211
Practice Address - Fax:941-387-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F94586Medicare UPIN
FL26364YMedicare PIN
FL26364AMedicare PIN