Provider Demographics
NPI:1912969833
Name:LEHMAN, GARY GRAYSON (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:GRAYSON
Last Name:LEHMAN
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 1:2881 S BUMBY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8704
Mailing Address - Country:US
Mailing Address - Phone:407-894-0005
Mailing Address - Fax:407-894-7759
Practice Address - Street 1:2881 S BUMBY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-8704
Practice Address - Country:US
Practice Address - Phone:407-894-0005
Practice Address - Fax:407-894-7759
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41509207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061430100Medicaid
FL266015600Medicaid
FL47740VMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FLK1675Medicare ID - Type UnspecifiedGROUP NUMBER
FL061430100Medicaid