Provider Demographics
NPI:1083625701
Name:LAM, GARY MAN (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:MAN
Last Name:LAM
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:PO BOX 496084
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-6084
Mailing Address - Country:US
Mailing Address - Phone:530-241-9800
Mailing Address - Fax:530-241-9808
Practice Address - Street 1:2510 AIRPARK DR 106
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2461
Practice Address - Country:US
Practice Address - Phone:530-241-9800
Practice Address - Fax:530-241-9808
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84812207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200368580Medicaid
CA00G848120Medicare PIN
IN200368580Medicaid
IN223420EEMedicare ID - Type Unspecified