=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396779088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERVASIO A LAMAS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2006
-----------------------------------------------------
Last Update Date | 08/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4308 ALTON RD #910
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-2840
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-695-0644
-----------------------------------------------------
Fax | 305-695-0662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 402808
-----------------------------------------------------
City | MIAMI BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33140-0808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-695-0644
-----------------------------------------------------
Fax | 305-695-0662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | ME69106
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------