Basic Information
| Provider Information | |||||||||
| NPI: | 1326095613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAM | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124320 | ||||||||
| FaxNumber: | 6235124321 | ||||||||
| Practice Location | |||||||||
| Address1: | 13555 W MCDOWELL RD | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853952624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235124320 | ||||||||
| FaxNumber: | 6235124321 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2006 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 3883 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 841420 | 05 | AZ | MEDICAID |