Provider Demographics
NPI:1710980321
Name:BARLAS, LANCE B (MD)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:B
Last Name:BARLAS
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 1:167 LYNCH CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2343
Mailing Address - Country:US
Mailing Address - Phone:707-763-4453
Mailing Address - Fax:707-763-5062
Practice Address - Street 1:167 LYNCH CREEK WAY
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-2343
Practice Address - Country:US
Practice Address - Phone:707-763-4453
Practice Address - Fax:707-763-5062
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2020-11-30
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
CAG40183174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G401830Medicaid
CA00G401830Medicare ID - Type UnspecifiedMEDICARE ID#
CA00G401830Medicaid