Provider Demographics
NPI:1215004403
Name:LAMB, GARY A (LPO, CO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:LAMB
Suffix:
Gender:M
Credentials:LPO, CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1742 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-2943
Mailing Address - Country:US
Mailing Address - Phone:325-672-5015
Mailing Address - Fax:325-672-0907
Practice Address - Street 1:1742 HICKORY ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2943
Practice Address - Country:US
Practice Address - Phone:325-672-5015
Practice Address - Fax:325-672-0907
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31OtherLICENSED PROSTHETIST-ORTH