Provider Demographics
NPI:1619122447
Name:LANCE L ERCANBRACK M.D.,P.C.
Entity Type:Organization
Organization Name:LANCE L ERCANBRACK M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERCANBRACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-283-6800
Mailing Address - Street 1:308 LOUISIANA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2158
Mailing Address - Country:US
Mailing Address - Phone:406-283-6800
Mailing Address - Fax:406-283-6815
Practice Address - Street 1:308 LOUISIANA AVE
Practice Address - Street 2:STE 1
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2158
Practice Address - Country:US
Practice Address - Phone:406-283-6800
Practice Address - Fax:406-283-6815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8804208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty