Healthcare Provider Details

I. General information

NPI: 1144668229
Provider Name (Legal Business Name): REYNALD ROGER LAMARRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
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 TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME128802
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME128802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: