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Individual

BETHANY K LAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
21 W COLUMBIA ST, ORLANDO, FL 32806-1133
(321) 841-5560
(407) 425-5947
Mailing address
21 W COLUMBIA ST, ORLANDO, FL 32806-1133
(321) 841-5560
(407) 425-5947

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103894
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
292662800
FL
Enumeration date
09/21/2006
Last updated
12/05/2012
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