Provider Demographics
NPI:1487638730
Name:JOBE, LANCE W (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:W
Last Name:JOBE
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 1:1201 S MILLER ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-3201
Mailing Address - Country:US
Mailing Address - Phone:509-661-3537
Mailing Address - Fax:509-665-6211
Practice Address - Street 1:1201 S MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3201
Practice Address - Country:US
Practice Address - Phone:509-661-3537
Practice Address - Fax:509-665-6211
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037359207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487638730Medicaid
WAP01422042OtherRR MEDICARE
WAG8920554, G8920553Medicare PIN