Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME24875 | FL |
Y | 111NI0900X | Internist | ME24875 | FL |
N | 207RH0000X | Hematologist | ME24875 | FL |
N | 207RX0202X | Medical Oncology | ME24875 | FL |
NPI | 1033143912 |
---|---|
Provider Name | Mrs. Lourdes M Mathew |
First Address | Leesburg, FL 31748 |
Second Address | Leesburg, FL 31748 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 30/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056387100 | (05) | FL |
056387101 | (05) | FL |
35146 | BCBS (01) | FL |
D54333 | (02) |