Provider Demographics
NPI:1881715704
Name:LAM, PETER THEINWIN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:THEINWIN
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:THEIN
Other - Middle Name:
Other - Last Name:WIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:36065 SANTA FE AVE.
Mailing Address - Street 2:
Mailing Address - City:FT. HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544
Mailing Address - Country:US
Mailing Address - Phone:254-553-1256
Mailing Address - Fax:
Practice Address - Street 1:36065 SANTA FE AVE.
Practice Address - Street 2:
Practice Address - City:FT. HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:254-553-1256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-404949171000000X
CT038898207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider