Provider Demographics
NPI:1740469030
Name:LAMAR, CORY DWAYNE (MD)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:DWAYNE
Last Name:LAMAR
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 1:9960 NW 116TH WAY STE 13
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1175
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:730 GOODLETTE-FRANK RD N STE 205
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5618
Practice Address - Country:US
Practice Address - Phone:239-667-5878
Practice Address - Fax:239-667-5838
Is Sole Proprietor?:No
Enumeration Date:2007-11-02
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1426062084E0001X, 2084N0400X
NH203422084N0400X
MT911912084N0400X
GA848892084N0400X, 208M00000X
NC2011-012072084N0400X
390200000X
FLME1426262084E0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084E0001XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyEpilepsy
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program