Lakeside Family Medicine, P.a.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

LAKESIDE FAMILY MEDICINE, P.A.

Practice address

4685 N Highway 19a
Mount Dora, FL 32757-2039

Phone

(352) 589-5900

Fax

(352) 589-5904

NPI assigned

Jun 4, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Gerald Edward Reynolds, D.O.

Title

President of Lakeside Family Medici

Phone

(352) 589-5900

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1212537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364169600000",
    "number": "1679732689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4685 N HIGHWAY 19A",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572039",
            "telephone_number": "352-589-5900",
            "fax_number": "352-589-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4685 N HIGHWAY 19A",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327572039",
            "telephone_number": "352-589-5900",
            "fax_number": "352-589-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY MEDICINE, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-04",
        "last_updated": "2013-03-25",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT OF LAKESIDE FAMILY MEDICI",
        "authorized_official_telephone_number": "352-589-5900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Primary Care Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.