Provider Demographics
NPI:1174622260
Name:BEN W. LAM, D.P.M., P.C.
Entity type:Organization
Organization Name:BEN W. LAM, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:940-766-1292
Mailing Address - Street 1:1702 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5627
Mailing Address - Country:US
Mailing Address - Phone:940-766-1292
Mailing Address - Fax:940-723-1650
Practice Address - Street 1:1702 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5627
Practice Address - Country:US
Practice Address - Phone:940-766-1292
Practice Address - Fax:940-723-1650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0642213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX219114001Medicaid
TXTXB111042Medicare PIN
TX219114001Medicaid