Provider Demographics
NPI:1124025069
Name:MARLOWE, PAUL LANCE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LANCE
Last Name:MARLOWE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1111 EMERALD BAY RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6207
Mailing Address - Country:US
Mailing Address - Phone:530-543-5659
Mailing Address - Fax:530-541-8723
Practice Address - Street 1:155 HWY 50
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449
Practice Address - Country:US
Practice Address - Phone:775-589-8900
Practice Address - Fax:775-588-7110
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4862207Q00000X
CAA39910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVP00250225OtherMEDICARE RR
NVV100703Medicare PIN
C67797Medicare UPIN
NV1124025069Medicaid