Provider Demographics
NPI:1356439491
Name:TAM, VINCENT K (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:K
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-6400
Practice Address - Fax:682-885-6101
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL47432086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150482102Medicaid
TX164239OtherPHCS PIN
TX0111727OtherCIGNA PIN
TX124060OtherSUPERIOR PIN
TX128733100OtherFIRSTCARE PIN
TX150482101Medicaid
TX8F3701OtherBCBSTX IND PIN
TX10006801OtherAMERIGROUP PIIN
TX1241346OtherUHC PIN
TX4244328OtherAETNA PIN
TX98391OtherFIRSTHEALTH PIN
TX98391OtherFIRSTHEALTH PIN
TX150482101Medicaid