Provider Demographics
NPI:1578820569
Name:LEE, LANCE THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:THOMAS
Last Name:LEE
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 1:320 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3454
Mailing Address - Country:US
Mailing Address - Phone:530-824-3283
Mailing Address - Fax:530-824-3285
Practice Address - Street 1:320 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3454
Practice Address - Country:US
Practice Address - Phone:530-824-3283
Practice Address - Fax:530-824-3285
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA145706207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR184935OtherMEDICARE PTAN