Provider Demographics
NPI:1932180239
Name:LETTS, PAMELA J (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:J
Last Name:LETTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3888 LYNDHURST CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34235-2421
Mailing Address - Country:US
Mailing Address - Phone:941-387-1211
Mailing Address - Fax:941-387-1220
Practice Address - Street 1:5370 GULF OF MEXICO DR
Practice Address - Street 2:
Practice Address - City:LONGBOAT KEY
Practice Address - State:FL
Practice Address - Zip Code:34228-2070
Practice Address - Country:US
Practice Address - Phone:941-387-1211
Practice Address - Fax:941-387-1220
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26364AMedicare ID - Type Unspecified
FLF94586Medicare UPIN