Healthcare Provider Details

I. General information

NPI: 1154320166
Provider Name (Legal Business Name): SANDRA W LAMPHIER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SANDRA W LAMPHIER MD

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16524 JESSAMINE RD
DADE CITY FL
33523-7432
US

IV. Provider business mailing address

12470 TELECOM DR STE 300W
TEMPLE TERRACE FL
33637-0904
US

V. Phone/Fax

Practice location:
  • Phone: 352-588-2165
  • Fax: 352-588-4628
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberME56268
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0056268
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: