Earl C Lysaker, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MEA5381 Issued in FL

Practice address

1397 Medical Park Blvd.
# 340
Wellington, FL 33414

Phone

(561) 795-2008

Fax

(561) 795-4214

NPI assigned

May 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191369600000",
    "number": "1104870831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 LAKE WORTH RD",
            "address_2": "#204",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334634727",
            "telephone_number": "561-968-7968",
            "fax_number": "561-964-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1397 MEDICAL PARK BLVD.",
            "address_2": "# 340",
            "city": "WELLINGTON",
            "state": "FL",
            "postal_code": "33414",
            "telephone_number": "561-795-2008",
            "fax_number": "561-795-4214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSAKER",
        "first_name": "EARL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "MEA5381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• M.F. Sabugo
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• Elizabeth B Macnaughton, ARNP
• James Madorma0705
• Rebecca Hope Magwood, PA-C

• Internal Medicine Physician in Wellington, FL
• Providers in Wellington, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.