MEDICARE: ANNIE LAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	BP10061107	TX
2	207Q00000X	Family Medicine Physician	S4329	TX

General Provider Information

NPI Number	:	1124556873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE LAM MD

Provider Business Mailing Address
First Line	:	9701 HARMON RD STE 141
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9701 HARMON RD STE 141
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76177-7602
Country	:	US
Telephone Number	:	214-947-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2017
Last Update Date	:	10/30/2020

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Directions to “ ANNIE LAM MD” Practice Location

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