Healthcare Provider Details

I. General information

NPI: 1578548277
Provider Name (Legal Business Name): MARK ELLIOTT LAMBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 W MIDWAY ST
OAK HARBOR WA
98278-4932
US

IV. Provider business mailing address

169 CANYON CREEK WAY
OCEANSIDE CA
92057-7518
US

V. Phone/Fax

Practice location:
  • Phone: 360-257-9806
  • Fax:
Mailing address:
  • Phone: 360-720-1764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number01055039A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01055039A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: