Healthcare Provider Details

I. General information

NPI: 1457415309
Provider Name (Legal Business Name): LANCE HUFF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 W WARNER RD
GILBERT AZ
85233-7266
US

IV. Provider business mailing address

1250 S CLEARVIEW AVE STE 100
MESA AZ
85209-3378
US

V. Phone/Fax

Practice location:
  • Phone: 480-722-9828
  • Fax:
Mailing address:
  • Phone: 480-988-9108
  • Fax: 480-813-4460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: