Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | M6717 | TX |
NPI | 1013122381 |
---|---|
Provider Name | Dr. Russell C Lam |
First Address | Dallas, TX 75231-4405 |
Second Address | Dallas, TX 75231-4420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 02/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187591603 | (05) | TX |