Healthcare Provider Details

I. General information

NPI: 1548883606
Provider Name (Legal Business Name): LANCE VAN TRUONG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N COLUMBIA RD
GRAND FORKS ND
58202-6098
US

IV. Provider business mailing address

1301 N COLUMBIA RD
GRAND FORKS ND
58202-6098
US

V. Phone/Fax

Practice location:
  • Phone: 701-777-2514
  • Fax:
Mailing address:
  • Phone: 701-777-2514
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberDO01271
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License Number1018915
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO01271
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number82712
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: