Provider Demographics
NPI:1578777140
Name:LAMADRID, ERNESTO J (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:J
Last Name:LAMADRID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 SW 2ND AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-6134
Mailing Address - Country:US
Mailing Address - Phone:352-505-0255
Mailing Address - Fax:352-505-0997
Practice Address - Street 1:1026 SW 2ND AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6134
Practice Address - Country:US
Practice Address - Phone:352-505-0255
Practice Address - Fax:352-505-0997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN101251K00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274984000Medicaid
FLACN101OtherLICENSE NUMBER
FLBL7624922OtherDEA NUMBER
FL274984000Medicaid