Provider Demographics
NPI:1780618298
Name:VAN ALLEN, KARY LAMAR (MD)
Entity type:Individual
Prefix:
First Name:KARY
Middle Name:LAMAR
Last Name:VAN ALLEN
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 1:62 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1115
Mailing Address - Country:US
Mailing Address - Phone:321-843-5851
Mailing Address - Fax:321-843-1673
Practice Address - Street 1:62 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1115
Practice Address - Country:US
Practice Address - Phone:321-843-5851
Practice Address - Fax:321-843-1673
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108263300Medicaid
FL44736AMedicare ID - Type Unspecified
FL255482800Medicaid