Provider Demographics
NPI:1689738478
Name:TAM, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:TAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 35949
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5949
Mailing Address - Country:US
Mailing Address - Phone:206-696-0765
Mailing Address - Fax:
Practice Address - Street 1:5380 S RAINBOW
Practice Address - Street 2:#110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1878
Practice Address - Country:US
Practice Address - Phone:702-838-3889
Practice Address - Fax:702-838-3890
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12069207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVI71240Medicare UPIN
NVV103428Medicare PIN