Provider Demographics
NPI:1104959923
Name:PULMONARY ASSOCIATES OF BRANDON
Entity type:Organization
Organization Name:PULMONARY ASSOCIATES OF BRANDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:LORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-251-2525
Mailing Address - Street 1:4020 SUN CITY CENTER BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-7201
Mailing Address - Country:US
Mailing Address - Phone:813-634-8969
Mailing Address - Fax:813-634-8969
Practice Address - Street 1:4020 SUN CITY CENTER BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5285
Practice Address - Country:US
Practice Address - Phone:813-634-8969
Practice Address - Fax:813-634-8969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID