Lake Cancer & Hematology PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

ME24875 Issued in FL

Legal business name

LAKE CANCER & HEMATOLOGY PA

Practice address

732 N 3Rd St
Leesburg, FL 34748-4442

Phone

(352) 728-2532

Fax

(352) 728-3004

NPI assigned

Jun 11, 2014

Organization subpart

No

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

Authorized official

Name

Dr. Lourdes M Mathew, MD

Title

Owner

Phone

(352) 728-2532

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402444800000",
    "number": "1366855967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "732 N 3RD ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347484442",
            "telephone_number": "352-728-2532",
            "fax_number": "352-728-3004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "732 N 3RD ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347484442",
            "telephone_number": "352-728-2532",
            "fax_number": "352-728-3004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE CANCER & HEMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A",
        "authorized_official_last_name": "MATHEW",
        "authorized_official_first_name": "LOURDES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "352-728-2532",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME24875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "056387100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Jeanne Ruelo Labasbas, P.T.
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• Specialist in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.