Provider Demographics
NPI:1639195050
Name:BAUGHMAN, LANCE EDMUND (PA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:EDMUND
Last Name:BAUGHMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3482
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83877-3482
Mailing Address - Country:US
Mailing Address - Phone:208-618-0690
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:T3-277
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-375-2000
Practice Address - Fax:907-375-5558
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK560363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKK153210Medicare ID - Type Unspecified
S24528Medicare UPIN