Provider Demographics
NPI:1649572249
Name:CARRION DINGUIS, LYSMAR (MD)
Entity Type:Individual
Prefix:
First Name:LYSMAR
Middle Name:
Last Name:CARRION DINGUIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 WESTWOOD BLVD STE 475
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-6027
Mailing Address - Country:US
Mailing Address - Phone:407-845-0384
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:4729 US HIGHWAY 98 S STE 201
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33812-4336
Practice Address - Country:US
Practice Address - Phone:863-646-9663
Practice Address - Fax:863-646-9664
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN476208D00000X
PR17887208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008701300Medicaid
PR17887OtherTEM
FLHE785ZOtherMEDICARE PTAN