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General NPI Number Information
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NPI Number | 1467606616
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Entity Type | Individual
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Provider Name | DR. LAWRENCE JOHN DE LAY
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Gender | Male
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 26 ORIGINS MAIN ST STE 219
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City | INLET BEACH
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State | FL
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Zip | 32461-8647
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Country | US
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Telephone | 850-407-2095
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Fax | 850-407-2095
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Provider Business Mailing Address
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Address Line | 26 ORIGINS MAIN ST STE 219
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City | INLET BEACH
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State | FL
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Zip | 32461-8647
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Country | US
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Telephone | 850-407-2095
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Fax | 850-407-2095
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD28817
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301505912
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 57260-20
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD61573411
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME155724
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License Number State | FL
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