Provider Demographics
NPI:1588726368
Name:L & W PEDIATRICS PA
Entity type:Organization
Organization Name:L & W PEDIATRICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-748-7500
Mailing Address - Street 1:4949 E STATE ROAD 64
Mailing Address - Street 2:PMB #139
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-5530
Mailing Address - Country:US
Mailing Address - Phone:941-748-7500
Mailing Address - Fax:941-748-7509
Practice Address - Street 1:4764 E STATE ROAD 64
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9058
Practice Address - Country:US
Practice Address - Phone:941-748-7500
Practice Address - Fax:941-748-7509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME70521208000000X
FLME57700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME70521OtherMEDICAL LICENSE DR WHITE
FLME57700OtherMEDICAL LICENSE DR LOPEZ
FLME70521OtherMEDICAL LICENSE DR WHITE