Edward B Lack (NPI# 1417955584, PAC ID# 9638068042) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DERMATOLOGY.
| Nation Provider ID (NPI) | 1417955584 |
| PAC ID by PECOS | 9638068042 |
| Professional Enrollment ID | I20130211000203 |
| Full Name | Edward B Lack |
| Organization Legal Name | LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC |
| Address |
6719 Gall Blvd Suite 106 Zephyrhills FL 33542-2568 |
| Phone Number | 8133555870 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE |
| Graduation Year | 1969 |
| Primary Specialty | DERMATOLOGY |
| Group Practice PAC ID | 4688579311 |
| Number of Group Practice Members | 154 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 6719 Gall Blvd, Suite 106, Zephyrhills, FL 33542-2568 | 8133555870 | LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC |
| Organization Legal Name | LEAVITT MEDICAL ASSOCIATES OF FLORIDA INC |
| Physicians | 160 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Etan Ariel Marks | Pathology | Leavitt Medical Associates of Florida Inc | 1300 Nw 17th Ave, Suite 130, Delray Beach, FL 33445-2588 |
| Matthew Hendricks | Physician Assistant | Leavitt Medical Associates of Florida Inc | 3 Sw 129th Ave, Suite 100, Pembroke Pines, FL 33027-1778 |
| Alexandra Gabrielle Feuer | Physician Assistant | Leavitt Medical Associates of Florida Inc | 200 Southpark Blvd, Suite 209, St Augustine, FL 32086-3129 |
| Caitlin Fredericka | Nurse Practitioner | Leavitt Medical Associates of Florida Inc | 2005 W Reynolds St, Plant City, FL 33563-4743 |
| Danielle Elizabeth Marino | Nurse Practitioner | Leavitt Medical Associates of Florida Inc | 12525 Philips Hwy, Suite 101, Jacksonville, FL 32256-3740 |
| Savina Aneja | Dermatology | Leavitt Medical Associates of Florida Inc | 400 W Fairbanks Ave, Winter Park, FL 32789-5084 |
| Valerie A Yantsos Ray | Pathology | Leavitt Medical Associates of Florida Inc | 14521 University Point Pl, Tampa, FL 33613-5424 |
| Stephen W Eubanks | Dermatology | Leavitt Medical Associates of Florida Inc | 1720 Dunlawton Ave, Suite 2, Port Orange, FL 32127-2916 |
| Ivette M. Sosa Seda | Dermatology | Leavitt Medical Associates of Florida Inc | 4100 Southpoint Dr E, Suite 1, Jacksonville, FL 32216-8710 |
| Mark M Fogg | Nurse Practitioner | Leavitt Medical Associates of Florida Inc | 11021 Spring Hill Dr, Spring Hill, FL 34608-5049 |
| Street Address |
6719 GALL BLVD SUITE 106 |
| City | ZEPHYRHILLS |
| State | FL |
| Zip | 33542-2568 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Shelley Tressa Butler | Nurse Practitioner | Florida Medical Clinic, LLC | 6719 Gall Blvd, Suite 207, Zephyrhills, FL 33542-2569 |
| Rita Gaye Morgan | Nurse Practitioner | Florida Medical Clinic, LLC | 6719 Gall Blvd, Suite 207, Zephyrhills, FL 33542-2569 |
| Charya Chhauv By Goldsmith | Dermatology | Leavitt Medical Associates of Florida Inc | 6719 Gall Blvd, Suite 106, Zephyrhills, FL 33542-2568 |
| Richard S Hamilton | Ophthalmology | Vitreous and Retina Consultants, Pa | 6719 Gall Blvd, Suite 206, Zephyrhills, FL 33542-2569 |
| Vipul V Kabaria | Interventional Pain Management | 6719 Gall Blvd, Suite 203, Zephyrhills, FL 33542-2569 | |
| George S Muthalakuzhy | Nephrology | 6719 Gall Blvd, Suite 201, Zephyrhills, FL 33542-2569 | |
| John Anthony Ferlita | Obstetrics/gynecology | Florida Hospital Physician Group Inc | 6719 Gall Blvd, Suite 208, Zephyrhills, FL 33542-2569 |
| Barkat Khan | Psychiatry | Florida Medical Clinic, LLC | 6719 Gall Blvd, Suite 207, Zephyrhills, FL 33542-2569 |
| Andrew P Brown | Nurse Practitioner | Florida Medical Clinic Pa | 6719 Gall Blvd, Suite 207, Zephyrhills, FL 33542-2569 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Resham Datta | Pain Management | Florida Medical Clinic, LLC | 36763 Eiland Blvd, Suite 201, Zephyrhills, FL 33542-0601 |
| Andres Delgado Jr. | Nurse Practitioner | Florida Medical Clinic, LLC | 36763 Eiland Blvd, Suite 201, Zephyrhills, FL 33542-0601 |
| Roshan B Mahtani | Family Medicine | Florida Medical Clinic, LLC | 6830 Gall Blvd, Zephyrhills, FL 33542-2503 |
| Neda Karimi Moghadasi | Nurse Practitioner | Florida Medical Clinic, LLC | 6830 Gall Blvd, Zephyrhills, FL 33542-2503 |
| Samir Kapoor | General Practice | Florida Medical Clinic, LLC | 6830 Gall Blvd, Zephyrhills, FL 33542-2503 |
| John Paul O Ludovice | Nurse Practitioner | Florida Medical Clinic, LLC | 6830 Gall Blvd, Zephyrhills, FL 33542-2503 |
| Vijaykumar Desai | Internal Medicine | Florida Medical Clinic, LLC | 6830 Gall Blvd, Zephyrhills, FL 33542-2503 |
| Bertram A Lewis Jr. | Urology | Florida Hospital Zephyrhills Inc | 6748 Gall Blvd, Zephyrhills, FL 33542-2511 |
| Ralph Highshaw | Urology | Florida Hospital Zephyrhills Inc | 6748 Gall Blvd, Zephyrhills, FL 33542-2511 |
| Amir Quefatieh | Pulmonary Disease | Florida Hospital Zephyrhills Inc | 6748 Gall Blvd, Zephyrhills, FL 33542-2511 |
| Find all physicians in zip 33542 | |||
| City | ZEPHYRHILLS |
| Zip Code | 33542 |
| Specialty | DERMATOLOGY |
| City + Specialty | ZEPHYRHILLS + DERMATOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.