Provider Demographics
NPI:1790875615
Name:LAM, ERNESTO S (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:S
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2221 BARNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-3131
Mailing Address - Country:US
Mailing Address - Phone:314-340-3242
Mailing Address - Fax:341-814-8542
Practice Address - Street 1:2220 LEMP AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-2700
Practice Address - Country:US
Practice Address - Phone:314-814-8688
Practice Address - Fax:314-814-8542
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO33184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO20021512Medicaid
MO20021512Medicaid