Provider Demographics
NPI:1730243841
Name:DR. AUDREY LEWERENZ-WALSH INC. DBA FAMILY DOCTORS
Entity type:Organization
Organization Name:DR. AUDREY LEWERENZ-WALSH INC. DBA FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEWERENZ-WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-748-8069
Mailing Address - Street 1:3303 MANATEE AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205
Mailing Address - Country:US
Mailing Address - Phone:941-748-8069
Mailing Address - Fax:941-748-6609
Practice Address - Street 1:3303 MANATEE AVENUE WEST
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205
Practice Address - Country:US
Practice Address - Phone:941-748-8069
Practice Address - Fax:941-748-6609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
FLOS4817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBCBSOther82700
FL064822100Medicaid
FLE32290Medicare UPIN
FL064822100Medicaid