Provider Demographics
NPI:1952306037
Name:BEAR, LANCE LEBRECHT (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:LEBRECHT
Last Name:BEAR
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 1:11511 CANTERWOOD BLVD NW
Mailing Address - Street 2:STE 205
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-5813
Mailing Address - Country:US
Mailing Address - Phone:253-530-2663
Mailing Address - Fax:253-530-2675
Practice Address - Street 1:11511 CANTERWOOD BLVD NW
Practice Address - Street 2:STE 205
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-5813
Practice Address - Country:US
Practice Address - Phone:253-530-2663
Practice Address - Fax:253-530-2675
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100891207X00000X
WAMD60112511207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0259384OtherSTATE L&I
WA0257049OtherSTATE L&I
WA0264384OtherSTATE L&I
MOG63871Medicare UPIN
WAG8886606Medicare PIN
WA0264384OtherSTATE L&I
WAG8893104Medicare PIN
WAG8886607Medicare PIN