Provider Demographics
NPI:1457696452
Name:LAMY, BONIFACE (IMG, USMLE-BC, ARNP)
Entity Type:Individual
Prefix:MR
First Name:BONIFACE
Middle Name:
Last Name:LAMY
Suffix:
Gender:M
Credentials:IMG, USMLE-BC, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4888 NW 183RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-2939
Mailing Address - Country:US
Mailing Address - Phone:305-685-5688
Mailing Address - Fax:
Practice Address - Street 1:4888 NW 183RD ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2939
Practice Address - Country:US
Practice Address - Phone:305-685-5688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-01
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9315397363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily