Basic Information
| Provider Information | |||||||||
| NPI: | 1871560953 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAMON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 MAIN STREET, SUITE 250 | ||||||||
| Address2: | |||||||||
| City: | NEW BRIGHTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551123271 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123267575 | ||||||||
| FaxNumber: | 6124542430 | ||||||||
| Practice Location | |||||||||
| Address1: | 2807 BROOKDALE DR | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554441844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7632379898 | ||||||||
| FaxNumber: | 7635034820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2006 | ||||||||
| LastUpdateDate: | 10/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 23578 | MN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 2084A0401X | 23578 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | H400474150 | 01 | MN | MEDICARE PTAN | OTHER | 646303700 | 05 | MN | MEDICAID |