Provider Demographics
NPI:1255403762
Name:LAKELAND DERMATOLOGY
Entity type:Organization
Organization Name:LAKELAND DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-647-2333
Mailing Address - Street 1:202 LAKE MIRIAM DR STE S1
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2188
Mailing Address - Country:US
Mailing Address - Phone:863-647-2333
Mailing Address - Fax:863-393-1995
Practice Address - Street 1:202 LAKE MIRIAM DR STE S1
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2188
Practice Address - Country:US
Practice Address - Phone:863-647-2333
Practice Address - Fax:863-393-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty