Healthcare Provider Details

I. General information

NPI: 1962997619
Provider Name (Legal Business Name): DR. JONATHAN MAXWELL LAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22023 FLORIDA STATE ROAD 7 SUITE 102
BOCA RATON FL
33428
US

IV. Provider business mailing address

1717 W WOOLBRIGHT RD
BOYNTON BEACH FL
33426-6319
US

V. Phone/Fax

Practice location:
  • Phone: 561-451-0655
  • Fax:
Mailing address:
  • Phone: 561-737-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number26509
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMT217678
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number292029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: