Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME0066914 | FL |
NPI | 1003855354 |
---|---|
Provider Name | Dr. Raymond Lakin |
First Address | Miami, FL 33126-2051 |
Second Address | Ft Lauderdale, FL 33308-1903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 06/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
378967500 | (05) | FL |
BL4206391 | DEA (01) | FL |
G12577 | (02) | FL |
ME0066914 | MEDICAL LICENSE (01) | FL |