Provider Demographics
NPI:1457425423
Name:AU, LAM ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:LAM
Middle Name:ALEXANDER
Last Name:AU
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 1:9275 SW 152ND ST
Mailing Address - Street 2:SUITE 108A
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1701
Mailing Address - Country:US
Mailing Address - Phone:305-255-2505
Mailing Address - Fax:305-254-8822
Practice Address - Street 1:9275 SW 152ND ST
Practice Address - Street 2:SUITE 108A
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-1701
Practice Address - Country:US
Practice Address - Phone:305-255-2505
Practice Address - Fax:305-254-8822
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044386207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34023OtherBCBS OF FLORIDA
FL049-4917-00Medicaid
34023Medicare ID - Type Unspecified
FL049-4917-00Medicaid