LAKE NEUROLOGY CLINIC, P.A.
Medical Practice at 9 St, Leesburg, FL

License number
Florida ME76490
Category
Medical Practice
Type
Specialist
Owner
Name: MARILYN C GLOVER
Title: OFFICE MANAGER
Phone: (352) 360-1122
Address
Address
608 S 9Th St STE A, Leesburg, FL 34748
National Provider ID: 1700958600
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Lake Neurology Clinic PA

Leesburg, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Registration:
Jun 10, 2002
Addresses:
PO Box 490123, Leesburg, FL 34749
608 S 9 St, Leesburg, FL 34748
PO Box 492722, Leesburg, FL 34749
State ID:
P02000064029
Business type:
Domestic for Profit Corporation
Managers:
Marilyn C. Glover (Office Manager),Marlyn A. Patterson-Lake Medical Doctor, Partner, President, Treasurer, Director, Secretary, inactive,Leann Donelly Secretary, inactive,...
Agent:
Charles D. Johnson

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