Individual
CLARENCE G TAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
421 CAMELOT DR, FOND DU LAC, WI 54935-8335
(920) 926-8472
(920) 926-8391
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8343
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
41026
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32549400
—
WI
01
—
P01397920
RAILROAD MEDICARE
WI
Enumeration date
08/21/2006
Last updated
10/21/2020
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