Healthcare Provider Details

I. General information

NPI: 1114906765
Provider Name (Legal Business Name): RYAN DANIEL LAMOND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 PASADENA AVE S
SOUTH PASADENA FL
33707-3717
US

IV. Provider business mailing address

2801 SEABREEZE DR S
GULFPORT FL
33707-3931
US

V. Phone/Fax

Practice location:
  • Phone: 727-341-7777
  • Fax:
Mailing address:
  • Phone: 619-995-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME106090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: