| NPI | 1144782632 |
|---|---|
| Doing Business As | LAKESIDE FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | BRENDA LARIE SOUTHERLAND CFO 501-625-7500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2019-04-03 |
| Last Update Date | 2019-04-03 |