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NPI Code Detail

MEDICARE: GILLES LACHANCE MD

MEDICARE: GILLES LACHANCE MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0001XRadiation Oncology Physician31601AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2779316OTHERAZAHCCCS

General Provider Information

NPI Number : 1235124397
Entity Type Code : Individual
Provider Name (Legal Business Name) : GILLES LACHANCE MD
Provider Business Mailing Address
First Line : 9250 N 3RD ST
Second Line : SUITE 4010
City : PHOENIX
State : AZ
Zip : 85020-2437
Country : US
Telephone Number : 602-633-3848
Fax Number : 602-633-3841
Provider Business Practice Location Address
First Line : 807 S PONDEROSA ST
Second Line :
City : PAYSON
State : AZ
Zip : 85541-5542
Country : US
Telephone Number : 928-474-5729
Fax Number : 928-472-8205
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2005
Last Update Date : 03/25/2015

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