10D1053865 CLIA NUMBER - PHYSICIANS GROUP LLC - DE

Laboratory Demographics

  • CLIA Code: 10D1053865
  • Facility Name: PHYSICIANS GROUP LLC - DE
  • Facility Address: 1509 SOUTH FLORIDA AVE STE 3
    LAKELAND, FL
    ZIP 33803
  • Facility Phone: 863 616-1370
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GREGORY A. BRONNER
  • NPI Number: 1013300912
  • Taxonomy: 207Q00000X - Family Medicine

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CLIA Record

Field Name Field Value
CLIA Number 10D1053865
LAB Type Physician Office
Facility Name PHYSICIANS GROUP LLC - DE
Street 1509 SOUTH FLORIDA AVE STE 3
City LAKELAND
State FL
ZIP 33803
Phone 863 616-1370
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Physician Office
Lab Director DR. GREGORY A. BRONNER

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This page was last updated on: 9/29/2025