Provider Demographics
NPI:1639367600
Name:LAM, ANH T (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANH
Middle Name:T
Last Name:LAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7691 GLACIER HWY
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7912
Mailing Address - Country:US
Mailing Address - Phone:907-789-5518
Mailing Address - Fax:907-523-6991
Practice Address - Street 1:7691 GLACIER HWY
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7912
Practice Address - Country:US
Practice Address - Phone:907-789-5518
Practice Address - Fax:907-523-6991
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4705213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPD18491Medicaid
AKU84981Medicare UPIN