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General NPI Number Information
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NPI Number | 1619122447
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Entity Type | Organization
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Legal Business Name | LANCE L ERCANBRACK M.D.,P.C.
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Dates
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Enumeration Date | 11/20/2008
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 308 LOUISIANA AVE STE 1
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City | LIBBY
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State | MT
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Zip | 59923-2158
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Country | US
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Telephone | 406-283-6800
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Fax | 406-283-6815
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Provider Business Mailing Address
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Address Line | 308 LOUISIANA AVE STE 1
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City | LIBBY
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State | MT
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Zip | 59923-2158
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Country | US
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Telephone | 406-283-6800
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Fax | 406-283-6815
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Authorized Official
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Title or Position | OWNER
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Name | LANCE L ERCANBRACK
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Credential | M.D.
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Telephone | 406-283-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 8804
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License Number State | MT
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