NPI 1043280449

Lara Diane Church, MD

Practitioner Family Medicine Physician Ponte Vedra, FL

Practice location

Address: 141 Hilden Rd STE 201 Credentialing Department, Ponte Vedra, FL 32081-8400
Phone: (904) 825-1941
Fax: (904) 829-2850
Mailing address: PO Box 45443, Salt Lake City, UT 84145-0443

Registered specialties

Family Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 207Q00000X Licence ME105548 (FL)

Other Family Medicine providers in Florida →

Registry record

NPI: 1043280449
Entity type: Individual
Sex (as registered): Female
NPI issued: 26 Jan 2006
Record last updated: 27 Dec 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.