Provider Demographics
NPI:1740885938
Name:PRIMARY CARE DR Z PPLC
Entity type:Organization
Organization Name:PRIMARY CARE DR Z PPLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPINAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-661-8593
Mailing Address - Street 1:38732 LAKEVIEW WALK
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6046
Mailing Address - Country:US
Mailing Address - Phone:305-469-8288
Mailing Address - Fax:
Practice Address - Street 1:38732 LAKEVIEW WALK
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6046
Practice Address - Country:US
Practice Address - Phone:305-469-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIMARY CARE DR Z PPLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty