Provider Demographics
NPI:1225069115
Name:HOLEMON, M LANCE (MD)
Entity Type:Individual
Prefix:MR
First Name:M
Middle Name:LANCE
Last Name:HOLEMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15255 N 40TH ST SUITE 105
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-867-2690
Mailing Address - Fax:602-404-1904
Practice Address - Street 1:5533 E BELL RD
Practice Address - Street 2:STE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-1256
Practice Address - Country:US
Practice Address - Phone:602-466-1111
Practice Address - Fax:602-466-1111
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ12368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ229410Medicaid
AZAH2015306OtherDEA
AZWCJAC01Medicare ID - Type Unspecified
AZ229410Medicaid