Healthcare Provider Details

I. General information

NPI: 1043491061
Provider Name (Legal Business Name): DAVID R LANCE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 AKRON RD
WOOSTER OH
44691-2518
US

IV. Provider business mailing address

1900 AKRON RD
WOOSTER OH
44691-2518
US

V. Phone/Fax

Practice location:
  • Phone: 330-264-4899
  • Fax: 330-264-4874
Mailing address:
  • Phone: 330-264-4899
  • Fax: 330-264-4874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number34003501L
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: