Healthcare Provider Details

I. General information

NPI: 1629603436
Provider Name (Legal Business Name): ONEMED FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10129 CLEAR VISTA ST
ORLANDO FL
32832-7164
US

IV. Provider business mailing address

10129 CLEAR VISTA ST
ORLANDO FL
32832-7164
US

V. Phone/Fax

Practice location:
  • Phone: 833-663-6331
  • Fax: 833-673-0418
Mailing address:
  • Phone: 833-663-6331
  • Fax: 833-673-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: REYNALD LAMARRE
Title or Position: MD
Credential:
Phone: 833-663-6331