1629241427 NPI number — DR. ROY NEAL LEMASTER M.D.

Table of content: DR. ROY NEAL LEMASTER M.D. (NPI 1629241427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629241427 NPI number — DR. ROY NEAL LEMASTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEMASTER
Provider First Name:
ROY
Provider Middle Name:
NEAL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629241427
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 N CLYDE MORRIS BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DAYTONA BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32114-2724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-254-4165
Provider Business Mailing Address Fax Number:
386-254-4339

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N CLYDE MORRIS BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DAYTONA BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32114-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-254-4165
Provider Business Practice Location Address Fax Number:
386-254-4339
Provider Enumeration Date:
04/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  093133 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: ME114102 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 007282400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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