Provider Demographics
NPI:1821287905
Name:KEITH LAMY MD, PA
Entity Type:Organization
Organization Name:KEITH LAMY MD, PA
Other - Org Name:FAMILY MEDICINE PRACTICE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-453-7356
Mailing Address - Street 1:1106 CLAYTON LN STE 102W
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-2433
Mailing Address - Country:US
Mailing Address - Phone:512-453-7356
Mailing Address - Fax:512-453-3590
Practice Address - Street 1:1106 CLAYTON LN STE 102W
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-2433
Practice Address - Country:US
Practice Address - Phone:512-453-7356
Practice Address - Fax:512-453-3590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00954WMedicare PIN