Provider Demographics
NPI:1194847699
Name:LAMB, JON PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:PATRICK
Last Name:LAMB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 SOPCHOPPY HWY
Mailing Address - Street 2:
Mailing Address - City:SOPCHOPPY
Mailing Address - State:FL
Mailing Address - Zip Code:32358-1023
Mailing Address - Country:US
Mailing Address - Phone:850-445-9182
Mailing Address - Fax:
Practice Address - Street 1:1200 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:AL
Practice Address - Zip Code:36340-1642
Practice Address - Country:US
Practice Address - Phone:334-684-3655
Practice Address - Fax:334-684-3231
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100212207Q00000X
ALMD.33147207Q00000X
ALMD.33417207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL281056500Medicaid
FL281056500Medicaid