Basic Information
| Provider Information | |||||||||
| NPI: | 1285716456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMA | ||||||||
| FirstName: | JACOBO | ||||||||
| MiddleName: | NOEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S DIXIE DR | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634211190 | ||||||||
| FaxNumber: | 8634227393 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 S DIXIE DR | ||||||||
| Address2: | |||||||||
| City: | HAINES CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634211190 | ||||||||
| FaxNumber: | 8634227393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 64989 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 373686500 | 05 | FL | MEDICAID |