LAKE WALES UROLOGY, LLC (NPI# 1063849248) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063849248 |
| Entity Type | Organization |
| Organization Name | LAKE WALES UROLOGY, LLC |
| Practice Address |
1110 Druid Cir Lake Wales FL 33853-4307 |
| Practice Telephone | 8638772411 |
| Practice Fax Number | 8638772377 |
| Mailing Telephone | 8638772411 |
| Mailing Fax Number | 8638772377 |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2013-10-04 |
| Authorized Official Name | MATTHEW WILLIAM LOUGHLIN (PRESIDENT) |
| Authorized Official Telephone | 8638772411 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | ME87080 | FL | Allopathic & Osteopathic Physicians |
| Street Address |
1110 DRUID CIR |
| City | LAKE WALES |
| State | FL |
| Zip Code | 33853-4307 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518964873 | James A Nelson | Family Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2005-07-01 |
| 1770132904 | Crystal Raye Renaud | Nurse Practitioner | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2019-09-10 |
| 1659884096 | Nakisha Lavon Watson | Family Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2017-11-07 |
| 1891187159 | William J Barringer | Family Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2015-02-24 |
| 1881710135 | Barringer,nelson & Holmes Pa | Family Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2007-03-21 |
| 1124188180 | Mahesh Gandhi Allam | Internal Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2006-12-11 |
| 1356429690 | William Barringer | Family Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2006-11-02 |
| 1124049317 | Medical Associates of Central Florida | Internal Medicine | 1110 Druid Cir, Lake Wales, FL 33853-4307 | 2006-07-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881218998 | Marcel Fundora | Dentist | 701 Fl-60, Lake Wales, FL 33853 | 2020-06-04 |
| 1386291599 | Adventist Health System /sunbelt, Inc. | Clinic/Center | 1255 Florida 60, Suite 300, Lake Wales, FL 33853 | 2019-08-22 |
| 1932753472 | Adeline Brooke Warren | Occupational Therapist | 512 S 11th Street, Lake Wales, FL 33853 | 2019-08-01 |
| 1033563580 | Amber Y Shepard | Family Medicine | 1255 Highway 60 E Ste 500, Lake Wales, FL 33853 | 2016-04-21 |
| 1174982458 | Ledesha Marie Dorothy Maduro | Dentist | 24185 Us Hwy 27 North, Lake Wales, FL 33853 | 2016-02-16 |
| 1528402435 | Buck Andreu Scott | Surgery | 407 S 11th St, Lake Wales, FL 33853 | 2013-04-22 |
| 1447598321 | Central Florida Health Care, Inc. | Dentist | 305 West Central Avenue, Lake Wales, FL 33853 | 2013-01-28 |
| 1972864932 | Kevin T Barlow, Pa. Dba: Winter Haven Audiology and Ridge Audiology. | Clinic/Center | 704 Sr 60 East, Lake Wales, FL 33853 | 2012-06-06 |
| 1316266364 | Elba M Lopez | Massage Therapist | 318 S. First Street, Lake Wales, FL 33853 | 2010-05-28 |
| 1063657955 | Lake Wales Medical Imaging Center One, Inc | Technician, Health Information | 1255 Highway 60 East 110, Lake Wales, FL 33853 | 2008-12-08 |
| Find all providers in zip 33853 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871913905 | James E Pilkington | Urology | 407 S 11th St, Lake Wales, FL 33853-4243 | 2014-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770193450 | Urotelemedicine LLC | Urology | 8669 Nw 36th St Ste 325, Doral, FL 33166-6698 | 2020-08-06 |
| 1700411618 | Ackerman Cancer Center, Pa | Urology | 159 North 3rd St, Macclenny, FL 32063-2103 | 2020-03-11 |
| 1043844483 | Jesse Aaron Ory | Urology | 5555 Ponce De Leon Blvd Fl 4, Coral Gables, FL 33146-2513 | 2020-02-25 |
| 1215591565 | Advent Health | Urology | 420 Celebration Ave, Celebration, FL 34747-4683 | 2019-04-23 |
| 1710442264 | Urologic Specialists of Central Florida Pllc | Urology | 575 S Wickham Rd Ste A, West Melbourne, FL 32904-1170 | 2019-02-08 |
| 1578028197 | Prody Urology, Pllc | Urology | 575 S Wickham Rd Ste B, West Melbourne, FL 32904-1170 | 2019-02-07 |
| 1366916843 | Dr. Carolyn Langford Urologic Solutions, LLC | Urology | 9400 Gladiolus Dr Ste 30, Fort Myers, FL 33908-9615 | 2019-01-17 |
| 1376016568 | Advanced Innovative Urology Pa | Urology | 4737 N Ocean Dr Ste 103, Lauderdale By The Sea, FL 33308-2920 | 2019-01-10 |
| 1306314281 | Urology Consultants of Boca Raton Pa | Urology | 825 Meadows Rd Ste 111, Boca Raton, FL 33486-2347 | 2018-11-08 |
| 1013490309 | Seetharam Bhat Kulthe Ramesh | Urology | 401 Celebration Pl Ste 200, Celebration, FL 34747-4971 | 2018-09-12 |
| Find all providers with the same taxonomy | ||||
| City | LAKE WALES |
| Zip Code | 33853 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.