Provider Demographics
NPI:1306166038
Name:LAM, GILLIAN (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:
Last Name:LAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GILLIAN
Other - Middle Name:
Other - Last Name:TAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:707 SW GAINES ST, CDRCP
Mailing Address - Street 2:PEDS GI, OFFICE 4212
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2403
Mailing Address - Country:US
Mailing Address - Phone:503-494-1078
Mailing Address - Fax:
Practice Address - Street 1:700 SW CAMPUS DR
Practice Address - Street 2:7TH FLOOR
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3107
Practice Address - Country:US
Practice Address - Phone:503-346-0640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-102282080P0206X
OR1770492080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology