MEDICARE: DR. STEPHEN L TAM 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	207R00000X	Internal Medicine Physician	12069	NV

General Provider Information

NPI Number	:	1689738478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN L TAM MD

Provider Business Mailing Address
First Line	:	PO BOX 35949
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-5949
Country	:	US
Telephone Number	:	206-696-0765
Fax Number	:

Provider Business Practice Location Address
First Line	:	5380 S RAINBOW
Second Line	:	#110
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1878
Country	:	US
Telephone Number	:	702-838-3889
Fax Number	:	702-838-3890

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	12/13/2007

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