Healthcare Provider Details

I. General information

NPI: 1053096990
Provider Name (Legal Business Name): BRIAN K LAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1397 WEIMER RD
TAOS NM
87571-6253
US

IV. Provider business mailing address

1397 WEIMER RD
TAOS NM
87571-6253
US

V. Phone/Fax

Practice location:
  • Phone: 575-758-8883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD2026-0426
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: