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General NPI Number Information
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NPI Number | 1053997080
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Entity Type | Individual
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Provider Name | TONY LAM CST
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Gender | Male
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Dates
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Enumeration Date | 03/21/2021
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Last Update Date | 03/21/2021
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Provider Practice Location Address
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Address Line | 3500 GASTON AVE
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City | DALLAS
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State | TX
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Zip | 75246-2088
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Country | US
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Telephone | 884-279-3627
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Fax |
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Provider Business Mailing Address
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Address Line | 712 CRAIG ST
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City | IRVING
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State | TX
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Zip | 75060-3989
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Country | US
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Telephone | 972-768-3282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 343910
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License Number State | TX
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