Provider Demographics
NPI:1114999810
Name:LANFERMAN, LONNIE LEE (DO)
Entity Type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:LEE
Last Name:LANFERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:LONNIE
Other - Middle Name:LEE
Other - Last Name:LANFERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1805 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:PELLA
Mailing Address - State:IA
Mailing Address - Zip Code:50219-8109
Mailing Address - Country:US
Mailing Address - Phone:641-780-7205
Mailing Address - Fax:
Practice Address - Street 1:1001 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-6427
Practice Address - Country:US
Practice Address - Phone:641-682-7511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA080185497OtherRAILROAD MEDICARE
IA1160655Medicaid
IAF77842Medicare UPIN
IAI6523Medicare PIN
IA1160655Medicaid