Lake Wales Urology, LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

ME87080 Issued in FL

Legal business name

LAKE WALES UROLOGY, LLC

Practice address

1110 Druid Cir
Lake Wales, FL 33853-4307

Phone

(863) 877-2411

Fax

(863) 877-2377

NPI assigned

Oct 2, 2013

Last updated

Oct 4, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Matthew William Loughlin, MD

Title

President

Phone

(863) 877-2411

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380844800000",
    "number": "1063849248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 DRUID CIR",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534307",
            "telephone_number": "863-877-2411",
            "fax_number": "863-877-2377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 DRUID CIR",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534307",
            "telephone_number": "863-877-2411",
            "fax_number": "863-877-2377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE WALES UROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-02",
        "last_updated": "2013-10-04",
        "status": "A",
        "authorized_official_last_name": "LOUGHLIN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "863-877-2411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "FL",
            "license": "ME87080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lake Wales Physician Services, LLC
• Lake Wales Primary Care Center, LLC
• Lake Wales SLC Opco LLC (The Club at Lakes Wales)
• Lake Wales SNF LLC
• Lake Wales Transit LLC
• Lakeland Regional Health System, Inc
• Junaid Anis Lakhani
• Maneet Lamba
• Deanna Larr, ARNP
• Franklin Dale Lastinger III, COTA/L

• Urology Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.