Provider Demographics
NPI:1568632396
Name:LIVE LONGER PHYSICIANS GROUP LLC
Entity Type:Organization
Organization Name:LIVE LONGER PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-244-9585
Mailing Address - Street 1:833 N ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:FL
Mailing Address - Zip Code:34266-8957
Mailing Address - Country:US
Mailing Address - Phone:863-993-1999
Mailing Address - Fax:863-993-0924
Practice Address - Street 1:833 N ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:FL
Practice Address - Zip Code:34266-8957
Practice Address - Country:US
Practice Address - Phone:863-993-1999
Practice Address - Fax:863-993-0924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19425207Q00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty