Provider Demographics
NPI:1265706709
Name:J NOEL LAMA, MD, PA
Entity type:Organization
Organization Name:J NOEL LAMA, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACOBO
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:LAMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-421-1190
Mailing Address - Street 1:101 S DIXIE DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-2844
Mailing Address - Country:US
Mailing Address - Phone:863-421-1190
Mailing Address - Fax:863-422-7393
Practice Address - Street 1:101 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-2844
Practice Address - Country:US
Practice Address - Phone:863-421-1190
Practice Address - Fax:863-422-7393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373686500Medicaid
FLF51703Medicare UPIN
FL373686500Medicaid