Provider Demographics
NPI:1700980273
Name:JANE LAMP MD PA
Entity type:Organization
Organization Name:JANE LAMP MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:I
Authorized Official - Last Name:LAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-333-6033
Mailing Address - Street 1:12957 PALMS WEST DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4989
Mailing Address - Country:US
Mailing Address - Phone:561-333-6033
Mailing Address - Fax:561-333-6057
Practice Address - Street 1:12957 PALMS WEST DR
Practice Address - Street 2:SUITE 104
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4989
Practice Address - Country:US
Practice Address - Phone:561-333-6033
Practice Address - Fax:561-333-6057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL35758OtherBLUE CROSS BLUE SHIELD
FL35758XMedicare ID - Type UnspecifiedINDIVIDUAL
FL35758OtherBLUE CROSS BLUE SHIELD
FLK7258Medicare ID - Type UnspecifiedGROUP