Medero Medical of Lake, LLC

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

12664 Issued in FL

Legal business name

MEDERO MEDICAL OF LAKE, LLC

Practice address

1109 SW 10TH St
Ocala, FL 34471-0325

Phone

(352) 629-3433

Fax

(352) 629-6796

NPI assigned

Jan 7, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Larry Mayfield

Title

Administrator

Phone

(352) 629-3433

Specialties & licenses 1

Addresses

Other names 1

• Medero Medical Lake Doing business as

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231286400000",
    "number": "1881831238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "312 S LAKE ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347485934",
            "telephone_number": "352-629-3433",
            "fax_number": "352-629-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 SW 10TH ST",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "344710325",
            "telephone_number": "352-629-3433",
            "fax_number": "352-629-6796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDERO MEDICAL OF LAKE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-01-07",
        "status": "A",
        "authorized_official_last_name": "MAYFIELD",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "352-629-3433",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "FL",
            "license": "12664",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medero Medical Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Occupational Medicine Physician in Ocala, FL
• Providers in Ocala, FL by specialty
• Occupational Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2009; 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.