Provider Demographics
NPI:1801387113
Name:LEHIGH MEDICAL AND RESEARCH CENTER, INC
Entity Type:Organization
Organization Name:LEHIGH MEDICAL AND RESEARCH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:REYES
Authorized Official - Last Name:GAVILAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-491-6159
Mailing Address - Street 1:5624 8TH ST W STE 112
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-6304
Mailing Address - Country:US
Mailing Address - Phone:239-491-6159
Mailing Address - Fax:239-230-7089
Practice Address - Street 1:5624 8TH ST W STE 112
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-6304
Practice Address - Country:US
Practice Address - Phone:239-491-6159
Practice Address - Fax:239-230-7089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty