Healthcare Provider Details

I. General information

NPI: 1053763896
Provider Name (Legal Business Name): SEAN S LAMB PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 W CHINDEN BLVD
MERIDIAN ID
83646-6690
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-809-2860
  • Fax: 208-809-2861
Mailing address:
  • Phone: 208-985-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: