Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | G84812 | CA |
NPI | 1083625701 |
---|---|
Provider Name | Gary Man Lam |
First Address | Redding, CA 96049-6084 |
Second Address | Redding, CA 96001-2461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 14/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200368580 | (05) | IN |
G59360 | (02) |