Provider Demographics
NPI:1215399050
Name:LOMAX, DEANNA (DO)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:LOMAX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 197515
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-7515
Mailing Address - Country:US
Mailing Address - Phone:941-782-4150
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:379 6TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-8820
Practice Address - Country:US
Practice Address - Phone:941-782-4150
Practice Address - Fax:941-782-4104
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS180892084P0800X
SC821352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL112404600Medicaid