Healthcare Provider Details

I. General information

NPI: 1891896163
Provider Name (Legal Business Name): KENNETH CECIL LAMB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 CALISTOGA RD # 399
SANTA ROSA CA
95409-3702
US

IV. Provider business mailing address

122 CALISTOGA RD # 399
SANTA ROSA CA
95409-3702
US

V. Phone/Fax

Practice location:
  • Phone: 707-525-3777
  • Fax: 707-538-8307
Mailing address:
  • Phone: 707-525-3777
  • Fax: 707-538-8307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberG27121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: