Healthcare Provider Details

I. General information

NPI: 1114919602
Provider Name (Legal Business Name): DAVID ANTHONY LAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 E BOYER ST
TARPON SPRINGS FL
34689-5501
US

IV. Provider business mailing address

5210 WEBB RD
TAMPA FL
33615-4518
US

V. Phone/Fax

Practice location:
  • Phone: 727-934-7638
  • Fax: 727-944-4052
Mailing address:
  • Phone: 813-882-9986
  • Fax: 813-341-3259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME85485
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME85485
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME85485
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME85485
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: