Provider Demographics
NPI:1114999737
Name:GOWEN, LANCE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:M
Last Name:GOWEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1101 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-2001
Mailing Address - Country:US
Mailing Address - Phone:402-228-3436
Mailing Address - Fax:402-223-4515
Practice Address - Street 1:515 RIVERCROSSING DR STE 180
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7900
Practice Address - Country:US
Practice Address - Phone:803-547-7541
Practice Address - Fax:803-548-0122
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE15208207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47065527613Medicaid
NE097204Medicare PIN
NEB68110Medicare UPIN