Provider Demographics
NPI:1578643219
Name:LAMERE, RICHARD G (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:G
Last Name:LAMERE
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 1:2648 HOLIDAY RANCH LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84060-6838
Mailing Address - Country:US
Mailing Address - Phone:435-655-1305
Mailing Address - Fax:
Practice Address - Street 1:2648 HOLIDAY RANCH LOOP RD
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-6838
Practice Address - Country:US
Practice Address - Phone:435-655-1305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7506208000000X
UT6264458 1205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133499OtherPHCS PIN
TX135136303Medicaid
TX135136308Medicaid
TXLAMRE77731OtherCCHIP PIN
TX645823OtherUHC PIN
TX080350401Medicaid
TX140442814Medicaid
1750369203OtherGRP NPI NUMBER
TX135136304Medicaid
TX00U87ZOtherBCBSTX GRP PIN
TX4110727OtherAETNA PIN
TX0906220OtherCIGNA PIN
TX1640385OtherFIRSTHEALTH PIN
TX86700FOtherBCBSTX IND PIN
TX135136308Medicaid
TX0906220OtherCIGNA PIN
TX0030BVMedicare ID - Type UnspecifiedGRP MEDICARE