Provider Demographics
NPI:1689625964
Name:LAMORE, VAN E (PA-C)
Entity Type:Individual
Prefix:
First Name:VAN
Middle Name:E
Last Name:LAMORE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 GEIST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3554
Mailing Address - Country:US
Mailing Address - Phone:907-456-3338
Mailing Address - Fax:907-456-3443
Practice Address - Street 1:3745 GEIST RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3554
Practice Address - Country:US
Practice Address - Phone:907-456-3338
Practice Address - Fax:907-456-3443
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI004580363AM0700X, 363AS0400X
IN10001088A363AS0400X
AKPADA631363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259370NMedicare PIN
MIP53401Medicare UPIN