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General NPI Number Information
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NPI Number | 1952452492
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Entity Type | Individual
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Provider Name | LAWRENCE EDWIN CHANCE JR. MD
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/31/2008
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Provider Practice Location Address
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Address Line | US HWY 491 NORTH NORTHERN NAVAJO MEDICAL CENTER
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City | SHIPROCK
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State | NM
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Zip | 87420
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Country | US
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Telephone | 505-368-6001
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Fax | 907-966-8606
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Provider Business Mailing Address
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Address Line | PO BOX 160 NORTHERN NAVAJO MEDICAL CENTER
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City | SHIPROCK
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State | NM
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Zip | 87420
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Country | US
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Telephone | 505-368-6001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3780
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License Number State | AK
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