Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 34003501L | OH |
NPI | 1043491061 |
---|---|
Provider Name | David R Lance |
First Address | Wooster, OH 44691-2518 |
Second Address | Wooster, OH 44691-2518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2007 |
Last Update Date | 09/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0519111 | (05) | OH |
C02525 | (02) | OH |