Provider Demographics
NPI:1437143666
Name:LAMBROU, FRED H JR (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:H
Last Name:LAMBROU
Suffix:JR
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 1:2 SHIRCLIFF WAY STE 715
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4759
Mailing Address - Country:US
Mailing Address - Phone:904-388-8446
Mailing Address - Fax:904-384-6261
Practice Address - Street 1:2 SHIRCLIFF WAY STE 715
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4759
Practice Address - Country:US
Practice Address - Phone:904-388-8446
Practice Address - Fax:904-384-6261
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2017-11-06
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
GAME026143207W00000X
FLME0053221207W00000X
FLME53221207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00394479AMedicaid
FL048036300Medicaid
FL05860OtherBCBS
FLD51438Medicare UPIN
GA00394479AMedicaid
FL048036300Medicaid