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General NPI Number Information
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NPI Number | 1770136541
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Entity Type | Individual
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Provider Name | CARLY ELIZABETH LAM PAC
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Gender | Female
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Dates
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Enumeration Date | 07/22/2019
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 660 GOLDEN RIDGE RD STE 250
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City | GOLDEN
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State | CO
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Zip | 80401-9541
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Country | US
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Telephone | 303-233-1223
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Fax |
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Provider Business Mailing Address
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Address Line | 660 GOLDEN RIDGE RD STE 250
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City | GOLDEN
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State | CO
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Zip | 80401-9541
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Country | US
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Telephone | 303-233-1223
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | PA.0005873
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | PA.0005873
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA.005873
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License Number State | CO
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