MEDICARE: DANIEL J LAMA 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	208800000X	Urology Physician	G684420	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340008330	OTHER	CA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G684220	OTHER	CA	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972517928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL J LAMA MD

Provider Business Mailing Address
First Line	:	489 E 21ST ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4816
Country	:	US
Telephone Number	:	909-882-2973
Fax Number	:	909-882-2681

Provider Business Practice Location Address
First Line	:	489 E 21ST ST
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-4816
Country	:	US
Telephone Number	:	909-882-2973
Fax Number	:	909-882-2681

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/02/2008

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Directions to “ DANIEL J LAMA MD” Practice Location

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