Graduated: 2016
NPI: 1457091639
Practice Locations (2)
RIDGEWOOD PHYSICIAN SERVICES, LLC
40100 HWY 27
DAVENPORT, FL 338375906
8634224971
LAKE WALES PHYSICIAN SERVICES, LLC
410 S 11TH ST
LAKE WALES, FL 338534203
8636761433
Source: CMS National Downloadable File, September 2026.