Provider Demographics
NPI:1669601357
Name:LAMONDA, JUSTIN GARY (MD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:GARY
Last Name:LAMONDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 S MORLEY ST
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-1948
Mailing Address - Country:US
Mailing Address - Phone:660-263-7062
Mailing Address - Fax:
Practice Address - Street 1:1145 S MORLEY ST
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-1948
Practice Address - Country:US
Practice Address - Phone:660-263-7062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012006598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2012006598OtherMO LICENSE