Provider Demographics
NPI:1902946247
Name:LAMA, TEOFILO (MD PA)
Entity Type:Individual
Prefix:
First Name:TEOFILO
Middle Name:
Last Name:LAMA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 BURNS ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:DC
Mailing Address - Zip Code:33410-4361
Mailing Address - Country:US
Mailing Address - Phone:561-799-9559
Mailing Address - Fax:561-799-9577
Practice Address - Street 1:3375 BURNS ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:DC
Practice Address - Zip Code:33410-4361
Practice Address - Country:US
Practice Address - Phone:561-799-9559
Practice Address - Fax:561-799-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082970A2086S0102X
FL884002086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068035100Medicaid
FL81237ZMedicare ID - Type Unspecified