Provider Demographics
NPI:1518045731
Name:HINTHER, LANCE RANDALL (MD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:RANDALL
Last Name:HINTHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2825 FORT MISSOULA ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804
Mailing Address - Country:US
Mailing Address - Phone:406-549-7556
Mailing Address - Fax:406-728-1868
Practice Address - Street 1:2825 FORT MISSOULA ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-549-7556
Practice Address - Fax:406-728-1868
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT6032207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0063726Medicaid
MT0063726Medicaid
C64253Medicare UPIN