Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G63915 | CA |
Y | 208600000X | Surgeon | G63915 | CA |
N | 2086X0206X | Surgical Oncologist | G63915 | CA |
N | 208G00000X | Cardiothoracic Vascular Surgeon | G63915 | CA |
NPI | 1295813889 |
---|---|
Provider Name | Dr. Lance L. Ludington |
First Address | Willits, CA 95490-5769 |
Second Address | Willits, CA 95490 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G639151 | (05) | CA |
F13372 | (02) | CA |