Provider Demographics
NPI:1013122381
Name:LAM, RUSSELL C (MD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:C
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8210 WALNUT HILL LN
Mailing Address - Street 2:SUITE 505
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-4405
Mailing Address - Country:US
Mailing Address - Phone:214-345-4160
Mailing Address - Fax:214-345-4165
Practice Address - Street 1:8210 WALNUT HILL LN STE 505
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4420
Practice Address - Country:US
Practice Address - Phone:214-345-4160
Practice Address - Fax:214-345-4165
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM67172086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187591603Medicaid
TX8F21206Medicare PIN