Healthcare Provider Details

I. General information

NPI: 1629241427
Provider Name (Legal Business Name): ROY NEAL LEMASTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 12/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N CLYDE MORRIS BLVD SUITE 200
DAYTONA BEACH FL
32114-2724
US

IV. Provider business mailing address

201 N CLYDE MORRIS BLVD SUITE 200
DAYTONA BEACH FL
32114-2724
US

V. Phone/Fax

Practice location:
  • Phone: 386-254-4165
  • Fax: 386-254-4339
Mailing address:
  • Phone: 386-254-4165
  • Fax: 386-254-4339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number093133
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME114102
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: