Provider Demographics
NPI:1235339748
Name:TINA M LAM M D P A
Entity Type:Organization
Organization Name:TINA M LAM M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-331-2010
Mailing Address - Street 1:7003 NW 11TH PLACE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3176
Mailing Address - Country:US
Mailing Address - Phone:352-331-2010
Mailing Address - Fax:352-331-2050
Practice Address - Street 1:7003 NW 11TH PL
Practice Address - Street 2:SUITE 4
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3176
Practice Address - Country:US
Practice Address - Phone:352-331-2010
Practice Address - Fax:352-331-2050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAF279Medicare PIN