Provider Demographics
NPI:1043718034
Name:DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC
Entity type:Organization
Organization Name:DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-839-3438
Mailing Address - Street 1:3345 S DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-7817
Mailing Address - Country:US
Mailing Address - Phone:813-839-3438
Mailing Address - Fax:
Practice Address - Street 1:3345 S DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-7817
Practice Address - Country:US
Practice Address - Phone:813-839-3438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLL652453703740OtherDRIVERS LIC