Provider Demographics
NPI:1164552394
Name:DAHM, LIDA INGE SWAFFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:LIDA
Middle Name:INGE SWAFFORD
Last Name:DAHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 BANNING DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-4706
Mailing Address - Country:US
Mailing Address - Phone:713-840-0274
Mailing Address - Fax:713-840-0274
Practice Address - Street 1:4634 BANNING DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-4706
Practice Address - Country:US
Practice Address - Phone:713-840-0274
Practice Address - Fax:713-840-0274
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD5712207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000TA974Medicaid
TXP000TA974Medicaid
TX000TA97Medicare ID - Type Unspecified