Provider Demographics
NPI:1760603369
Name:HO, ALLAN LAM (MD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:LAM
Last Name:HO
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 1:2407 W CERVANTES ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-7150
Mailing Address - Country:US
Mailing Address - Phone:850-791-6200
Mailing Address - Fax:850-791-6440
Practice Address - Street 1:2407 W CERVANTES ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-7150
Practice Address - Country:US
Practice Address - Phone:850-791-6200
Practice Address - Fax:850-791-6440
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124454207Q00000X
WI55063-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010335000Medicaid
FL010335000Medicaid