Provider Demographics
NPI:1194834994
Name:LAMAR, WAYNE TERRY (MD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:TERRY
Last Name:LAMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2168 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655
Mailing Address - Country:US
Mailing Address - Phone:662-234-8432
Mailing Address - Fax:662-234-5267
Practice Address - Street 1:2168 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-8432
Practice Address - Fax:662-234-5267
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05285207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3065OtherBLUE CROSS BLUE SHIELD
MS01152790Medicaid
MS3065OtherBLUE CROSS BLUE SHIELD