Basic Information
Provider Information | |||||||||
NPI: | 1013004605 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MARK LAMET MD PA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | THE CENTER FOR GASTROINTESTINAL DISORDERS | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1150 N 35TH AVENUE | ||||||||
Address2: | SUITE 445 | ||||||||
City: | HOLLYWOOD | ||||||||
State: | FL | ||||||||
PostalCode: | 33021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9549617771 | ||||||||
FaxNumber: | 9549619633 | ||||||||
Practice Location | |||||||||
Address1: | 1150 N 35TH AVENUE | ||||||||
Address2: | SUITE 445 | ||||||||
City: | HOLLYWOOD | ||||||||
State: | FL | ||||||||
PostalCode: | 33021 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9549617771 | ||||||||
FaxNumber: | 9549619633 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/06/2006 | ||||||||
LastUpdateDate: | 08/07/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | LAMET | ||||||||
AuthorizedOfficialFirstName: | MARK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
AuthorizedOfficialTelephone: | 9549617771 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
ID | Type | State | Issuer | Description | 064455200 | 05 | FL |   | MEDICAID | 10D0709356 | 01 |   | CLIA | OTHER |