Provider Demographics
NPI:1073530556
Name:WHITNEY, LANCE CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:CRAIG
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 OHAOHA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-7707
Mailing Address - Country:US
Mailing Address - Phone:808-269-0979
Mailing Address - Fax:808-573-4786
Practice Address - Street 1:1360 S BERETANIA ST
Practice Address - Street 2:#215
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1520
Practice Address - Country:US
Practice Address - Phone:808-532-3711
Practice Address - Fax:808-532-3713
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11872207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A015OtherCHAMPUS TRICARE
00A0237311OtherHMSA
517344-01OtherACS
P00022043Medicare ID - Type Unspecified
517344-01OtherACS
H54834Medicare ID - Type Unspecified