Provider Demographics
NPI:1134520422
Name:LAMM, GARY
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4524
Mailing Address - Country:US
Mailing Address - Phone:650-201-9641
Mailing Address - Fax:
Practice Address - Street 1:610 ELM ST
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-8401
Practice Address - Country:US
Practice Address - Phone:650-591-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-06
Last Update Date:2014-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program