Provider Demographics
NPI:1376529644
Name:MAYFIELD, LANCE JOHN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:JOHN
Last Name:MAYFIELD
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1113 CRAIG ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-2720
Mailing Address - Country:US
Mailing Address - Phone:360-417-0695
Mailing Address - Fax:360-417-5899
Practice Address - Street 1:1 EDIZ HOOK
Practice Address - Street 2:U.S. COAST GUARD CLINIC
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-2201
Practice Address - Country:US
Practice Address - Phone:360-417-5891
Practice Address - Fax:360-417-5988
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004207363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical