Provider Demographics
NPI:1447333810
Name:LANMAR MEDICAL OFFICE
Entity type:Organization
Organization Name:LANMAR MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESSIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-228-7667
Mailing Address - Street 1:1800 SW 1ST ST
Mailing Address - Street 2:#324
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1960
Mailing Address - Country:US
Mailing Address - Phone:305-228-7667
Mailing Address - Fax:
Practice Address - Street 1:1800 SW 1ST ST
Practice Address - Street 2:#324
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1960
Practice Address - Country:US
Practice Address - Phone:305-228-7667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8754Medicare ID - Type UnspecifiedMEDICAL OFFICE