Provider Demographics
NPI:1285682997
Name:LANCEY, ROBERT W (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:LANCEY
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:DC043.00
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-2375
Practice Address - Fax:573-884-3037
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD118788207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO204669204Medicaid
KS2086756601OtherKANSAS MEDICAID
MO409927OtherHEALTHLINK
MO124667OtherBLUE SHIELD/BLUE CHOICE
MO401254OtherUNITED HEALTCARE
MO124667OtherBLUE SHIELD/BLUE CHOICE
MO409927OtherHEALTHLINK
MO401254OtherUNITED HEALTCARE
MOP00479189Medicare PIN
MO962425236Medicare PIN