Provider Demographics
NPI:1740645357
Name:JACK LOMANO MD
Entity type:Organization
Organization Name:JACK LOMANO MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOMANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-470-8809
Mailing Address - Street 1:15644 CALOOSA CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6736
Mailing Address - Country:US
Mailing Address - Phone:239-470-8809
Mailing Address - Fax:239-236-3900
Practice Address - Street 1:15644 CALOOSA CREEK CIR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6736
Practice Address - Country:US
Practice Address - Phone:239-470-8809
Practice Address - Fax:239-236-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33323261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME33323OtherFLORIDA MEDICAL LICENSE