Provider Demographics
NPI:1881642965
Name:PULMONARY AND SLEEP CENTER OF LAKE CITY PA
Entity type:Organization
Organization Name:PULMONARY AND SLEEP CENTER OF LAKE CITY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIOGENES
Authorized Official - Middle Name:FRANSISCO
Authorized Official - Last Name:DUARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-754-1711
Mailing Address - Street 1:320 NW TURNER AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-8306
Mailing Address - Country:US
Mailing Address - Phone:386-754-1711
Mailing Address - Fax:386-754-1712
Practice Address - Street 1:320 NW TURNER AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8306
Practice Address - Country:US
Practice Address - Phone:386-754-1711
Practice Address - Fax:386-754-1712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87814207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8H4MDOtherFL BLUE
FLK8209Medicare PIN
FLH97901Medicare UPIN