Provider Demographics
NPI:1013004605
Name:MARK LAMET MD PA
Entity Type:Organization
Organization Name:MARK LAMET MD PA
Other - Org Name:THE CENTER FOR GASTROINTESTINAL DISORDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-961-7771
Mailing Address - Street 1:1150 N 35TH AVENUE
Mailing Address - Street 2:SUITE 445
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021
Mailing Address - Country:US
Mailing Address - Phone:954-961-7771
Mailing Address - Fax:954-961-9633
Practice Address - Street 1:1150 N 35TH AVENUE
Practice Address - Street 2:SUITE 445
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-961-7771
Practice Address - Fax:954-961-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL064455200Medicaid
10D0709356OtherCLIA
FL064455200Medicaid