Provider Demographics
NPI:1487775250
Name:ROY, LISBETH WINTERBOTTOM (DO)
Entity type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:WINTERBOTTOM
Last Name:ROY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6400 N ANDREWS AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2114
Mailing Address - Country:US
Mailing Address - Phone:561-444-7751
Mailing Address - Fax:813-354-3562
Practice Address - Street 1:6400 N ANDREWS AVE
Practice Address - Street 2:STE 120
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2114
Practice Address - Country:US
Practice Address - Phone:561-444-7751
Practice Address - Fax:813-354-3562
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9873208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice