Provider Demographics
NPI:1689647133
Name:LAM, VAN (MD)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:
Last Name:LAM
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 1:1601 W HEBRON PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6342
Mailing Address - Country:US
Mailing Address - Phone:972-426-8675
Mailing Address - Fax:972-492-4694
Practice Address - Street 1:1601 W HEBRON PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6342
Practice Address - Country:US
Practice Address - Phone:972-426-8675
Practice Address - Fax:972-492-4694
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0361208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX041920202OtherMEDICAID OTHER
TX041920201Medicaid
TX8G8169OtherMEDICARE ID, UNSPECIFIED
TX041920201Medicaid
TX041920201Medicaid