Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | ML20007565 | WA |
Y | 207YP0228X | Pediatric Otolaryngology | 157387 | OR |
N | 207YP0228X | Pediatric Otolaryngology | 35.095296 | OH |
NPI | 1104938091 |
---|---|
Provider Name | Derek J Lam |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 11/09/2012 |