Provider Demographics
NPI:1780942763
Name:LAKE WASHINGTON FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:LAKE WASHINGTON FAMILY PRACTICE, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:AURAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-242-7353
Mailing Address - Street 1:3140 SUNTREE BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5789
Mailing Address - Country:US
Mailing Address - Phone:321-242-7353
Mailing Address - Fax:321-242-7306
Practice Address - Street 1:3140 SUNTREE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5789
Practice Address - Country:US
Practice Address - Phone:321-242-7353
Practice Address - Fax:321-242-7306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty