Provider Demographics
NPI:1538546007
Name:PHYSICIANS LIFE CENTERS, LLC
Entity type:Organization
Organization Name:PHYSICIANS LIFE CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-325-6504
Mailing Address - Street 1:1048 GOODLETTE RD N
Mailing Address - Street 2:101
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5491
Mailing Address - Country:US
Mailing Address - Phone:239-325-6504
Mailing Address - Fax:
Practice Address - Street 1:1048 GOODLETTE RD N
Practice Address - Street 2:101
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5491
Practice Address - Country:US
Practice Address - Phone:239-325-6504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty