Healthcare Provider Details

I. General information

NPI: 1336490143
Provider Name (Legal Business Name): RONALD MARVIN LAMPERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11811 N.N. TATUM BLVD. SUITE 3031
PHOENIX AZ
85028-1621
US

IV. Provider business mailing address

1365 S. HIGH VALLEY RANCH ROAD
PRESCOTT AZ
96303
US

V. Phone/Fax

Practice location:
  • Phone: 602-870-3355
  • Fax: 602-870-3044
Mailing address:
  • Phone: 602-870-3355
  • Fax: 602-870-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number17314
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: