Provider Demographics
NPI:1457452674
Name:DUNLOP, LANCE RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:RUSSELL
Last Name:DUNLOP
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 1:1650 COWLES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5907
Mailing Address - Country:US
Mailing Address - Phone:907-458-5250
Mailing Address - Fax:074-589-5255
Practice Address - Street 1:1650 COWLES ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5907
Practice Address - Country:US
Practice Address - Phone:907-458-5250
Practice Address - Fax:907-458-5255
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4300272083A0300X, 2084P0800X, 2084P0804X
AK1007742083A0300X, 2084P0804X, 2084P0800X
NJ25MA093494002083A0300X, 2084P0800X, 2084P0804X
PAMT1841392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry