Provider Demographics
NPI:1275693137
Name:LEZAMA, NOEL E (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:E
Last Name:LEZAMA
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 1:8074 NW 103RD ST STE 20
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2256
Mailing Address - Country:US
Mailing Address - Phone:305-826-4307
Mailing Address - Fax:305-826-6790
Practice Address - Street 1:8074 NW 103RD ST
Practice Address - Street 2:SUITE 20
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016
Practice Address - Country:US
Practice Address - Phone:305-826-4307
Practice Address - Fax:305-826-6790
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL90883208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004484000Medicaid
I48137Medicare UPIN