Provider Demographics
NPI:1003015454
Name:MONTEAU, LANCE (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:MONTEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2223 E ROSSER AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4949
Mailing Address - Country:US
Mailing Address - Phone:701-857-8000
Mailing Address - Fax:701-857-8070
Practice Address - Street 1:1290 WONDER WORLD DR STE 1100
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7969
Practice Address - Country:US
Practice Address - Phone:512-393-3325
Practice Address - Fax:512-393-3328
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ND11622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15424Medicaid
NDN718551Medicare PIN