Provider Demographics
NPI:1366428633
Name:LAMANNA, JOHN R JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LAMANNA
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-1357
Mailing Address - Country:US
Mailing Address - Phone:239-278-3600
Mailing Address - Fax:239-226-4650
Practice Address - Street 1:4300 KINGS HWY
Practice Address - Street 2:STE 500
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2917
Practice Address - Country:US
Practice Address - Phone:239-344-2325
Practice Address - Fax:941-764-6176
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME93548208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1466149OtherUNITED
FL274945900Medicaid
FL4091418OtherAETNA
FL274945900Medicaid
F69574Medicare UPIN