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NPI Code Detail

MEDICARE: LANCE DUSTIN ROBERT DO

MEDICARE: LANCE DUSTIN ROBERT DO
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
1207Q00000XFamily Medicine Physician8380171-1204UT

General Provider Information

NPI Number : 1578852174
Entity Type Code : Individual
Provider Name (Legal Business Name) : LANCE DUSTIN ROBERT DO
Provider Business Mailing Address
First Line : PO BOX 27128
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84127-0128
Country : US
Telephone Number : 801-495-7900
Fax Number :
Provider Business Practice Location Address
First Line : 12473 S MINUTEMAN DR
Second Line :
City : DRAPER
State : UT
Zip : 84020-7870
Country : US
Telephone Number : 801-495-7900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2011
Last Update Date : 02/04/2016

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