Provider Demographics
NPI:1669464053
Name:LAMBERT, JOHN A (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3784
Mailing Address - Country:US
Mailing Address - Phone:772-480-1122
Mailing Address - Fax:772-480-1122
Practice Address - Street 1:1355 20TH AVE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3784
Practice Address - Country:US
Practice Address - Phone:772-480-1122
Practice Address - Fax:772-480-1122
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3356363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLX1623OtherBLUE CROSS
FLP00316934OtherRAILROAD
FLP00316934OtherRAILROAD
FLE2364YMedicare ID - Type Unspecified