Provider Demographics
NPI:1578548277
Name:LAMBERT, MARK ELLIOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOTT
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 CANYON CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92057-7518
Mailing Address - Country:US
Mailing Address - Phone:360-720-1764
Mailing Address - Fax:
Practice Address - Street 1:1045 W MIDWAY ST
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98278-4932
Practice Address - Country:US
Practice Address - Phone:360-257-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-14
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055039A171000000X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No171000000XOther Service ProvidersMilitary Health Care Provider