Healthcare Provider Details

I. General information

NPI: 1346355054
Provider Name (Legal Business Name): LANCE L. GOETZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

1201 BROAD ROCK BLVD
RICHMOND VA
23249-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5455
  • Fax: 804-675-5223
Mailing address:
  • Phone: 804-675-5455
  • Fax: 804-675-5223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License NumberK4901
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: