Provider Demographics
NPI:1710930607
Name:LANCE, RAYMOND S (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:S
Last Name:LANCE
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 1:1401 E TRENT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2902
Mailing Address - Country:US
Mailing Address - Phone:509-747-3147
Mailing Address - Fax:509-747-0020
Practice Address - Street 1:1401 E TRENT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2902
Practice Address - Country:US
Practice Address - Phone:509-747-3147
Practice Address - Fax:509-747-0020
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240091208800000X
WAMD00039663208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA201665OtherBC/BS
VA10010603OtherSENTARA
VA010285976Medicaid
VA1710930607OtherANTHEM
AKMD4546Medicaid
AK152376Medicare ID - Type Unspecified
AKMD4546Medicaid
AKH09880Medicare UPIN