Healthcare Provider Details

I. General information

NPI: 1114011863
Provider Name (Legal Business Name): JAN LEAH LAMB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 28 1/4 RD
GRAND JUNCTION CO
81506-6019
US

IV. Provider business mailing address

PO BOX 1687
GRAND JUNCTION CO
81502-1687
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-2670
  • Fax: 970-263-2686
Mailing address:
  • Phone: 970-256-6322
  • Fax: 970-263-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42174
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: