Provider Demographics
NPI:1821798315
Name:LANCE MIDDLETON M.D., PH.D., P.C.
Entity Type:Organization
Organization Name:LANCE MIDDLETON M.D., PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-335-4986
Mailing Address - Street 1:32 LESLIE CT
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-2921
Mailing Address - Country:US
Mailing Address - Phone:225-335-4986
Mailing Address - Fax:
Practice Address - Street 1:3030 BRIDGEWAY STE 212
Practice Address - Street 2:
Practice Address - City:SAUSALITO
Practice Address - State:CA
Practice Address - Zip Code:94965-2898
Practice Address - Country:US
Practice Address - Phone:707-504-9982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health