Provider Demographics
NPI:1063403111
Name:LAMB, JOSEPH JEFFREY (PAC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JEFFREY
Last Name:LAMB
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 E POLK ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-2136
Practice Address - Country:US
Practice Address - Phone:512-715-6400
Practice Address - Fax:512-715-6401
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL94545Medicare ID - Type UnspecifiedMEDICARE#
ILS93273Medicare UPIN
IL970018952Medicare ID - Type UnspecifiedRAILROAD#