Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 07855 | AZ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 11990 | MN |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 43835 | AZ |
N | 204E00000X | Oral & Maxillofacial Surgeon | 51977 | MN |
NPI | 1063485829 |
---|---|
Provider Name | Derek H Lamb |
First Address | Scottsdale, AZ 85251-5630 |
Second Address | Scottsdale, AZ 85251-5630 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 30/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33826700 | (05) | WI |
832965600 | (05) | MN |
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
P00813445 | RAILROAD MEDICARE (01) | MN |
V02605 | (02) |