Provider Demographics
NPI:1396945705
Name:LAMBERT, BENJAMIN WADE (IDC)
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WADE
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JWTC UNIT 35951
Mailing Address - Street 2:
Mailing Address - City:CAMP GONSALVES
Mailing Address - State:FPO
Mailing Address - Zip Code:AP
Mailing Address - Country:JP
Mailing Address - Phone:01181611-722-2238
Mailing Address - Fax:01181611-722-2235
Practice Address - Street 1:JWTC UNIT 35951
Practice Address - Street 2:
Practice Address - City:CAMP GONSALVES
Practice Address - State:FPO AP
Practice Address - Zip Code:96602 5951
Practice Address - Country:JP
Practice Address - Phone:01181611-722-2238
Practice Address - Fax:01181611-722-2235
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman