Provider Demographics
NPI:1497952899
Name:LAM, PAUL BAO (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BAO
Last Name:LAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14275 SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-8430
Mailing Address - Country:US
Mailing Address - Phone:720-366-4635
Mailing Address - Fax:
Practice Address - Street 1:6600 W 120TH AVE UNIT A
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-6937
Practice Address - Country:US
Practice Address - Phone:720-366-4635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2267174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist