Provider Demographics
NPI:1700907912
Name:LAMB PLASTIC SURGERY CENTER PC
Entity Type:Organization
Organization Name:LAMB PLASTIC SURGERY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-237-9592
Mailing Address - Street 1:1507 SOUTH UNIVERSITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103
Mailing Address - Country:US
Mailing Address - Phone:701-237-9592
Mailing Address - Fax:701-298-3883
Practice Address - Street 1:1507 SOUTH UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103
Practice Address - Country:US
Practice Address - Phone:701-237-9592
Practice Address - Fax:701-298-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND52612086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty