Healthcare Provider Details

I. General information

NPI: 1356449532
Provider Name (Legal Business Name): PAUL L LANCASTER AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 N MILWAUKEE ST STE A
BOISE ID
83704-7107
US

IV. Provider business mailing address

1740 N MILWAUKEE ST STE A
BOISE ID
83704-7107
US

V. Phone/Fax

Practice location:
  • Phone: 208-658-0238
  • Fax: 208-658-0302
Mailing address:
  • Phone: 208-658-0238
  • Fax: 208-658-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberRPE 4084
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23383
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberHT 8138
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAUD-1599
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: