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NPI Code Detail

MEDICARE: DR. CRAIG PHILLIP LANCE M.D.

MEDICARE: DR. CRAIG PHILLIP LANCE M.D.
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
12085R0204XVascular & Interventional Radiology PhysicianMT210197PA
2390200000XStudent in an Organized Health Care Education/Training Program
32085R0202XDiagnostic Radiology PhysicianMD2017-0486NM

General Provider Information

NPI Number : 1851680763
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CRAIG PHILLIP LANCE M.D.
Provider Business Mailing Address
First Line : PO BOX 3212
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46206-3212
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 301 E MIEL DE LUNA AVE
Second Line :
City : TUCUMCARI
State : NM
Zip : 88401-3810
Country : US
Telephone Number : 800-841-4236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2011
Last Update Date : 03/17/2018

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