Provider Demographics
NPI:1013979913
Name:LAMBERT, GARY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:LAMBERT
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:PO BOX 10210
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77842-0210
Mailing Address - Country:US
Mailing Address - Phone:979-696-0267
Mailing Address - Fax:979-694-4703
Practice Address - Street 1:1602 ROCK PRAIRIE RD
Practice Address - Street 2:STE. 1100
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-8306
Practice Address - Country:US
Practice Address - Phone:979-693-2586
Practice Address - Fax:979-693-7327
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6855207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G2369OtherBLUE CROSS
TX130904901Medicaid
TXC18111Medicare UPIN
TX130904901Medicaid
TX8906B6Medicare PIN