Provider Demographics
NPI:1659366425
Name:LAMP, JANE (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:LAMP
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 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4932
Mailing Address - Country:US
Mailing Address - Phone:561-333-6033
Mailing Address - Fax:561-333-6057
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4932
Practice Address - Country:US
Practice Address - Phone:561-333-6033
Practice Address - Fax:561-333-6057
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262739600Medicaid
FL262739600Medicaid
FLH20708Medicare UPIN