Provider Demographics
NPI:1952452492
Name:CHANCE, LAWRENCE EDWIN JR (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:EDWIN
Last Name:CHANCE
Suffix:JR
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:PO BOX 160
Mailing Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER
Mailing Address - City:SHIPROCK
Mailing Address - State:NM
Mailing Address - Zip Code:87420
Mailing Address - Country:US
Mailing Address - Phone:505-368-6001
Mailing Address - Fax:
Practice Address - Street 1:US HWY 491 NORTH
Practice Address - Street 2:NORTHERN NAVAJO MEDICAL CENTER
Practice Address - City:SHIPROCK
Practice Address - State:NM
Practice Address - Zip Code:87420
Practice Address - Country:US
Practice Address - Phone:505-368-6001
Practice Address - Fax:907-966-8606
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK37802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45826226Medicaid
AZ242390Medicaid
NM63250233Medicaid
AKMD3780Medicaid
8HG538Medicare PIN
AK8EZ23BMedicare ID - Type Unspecified
NM63250233Medicaid
320059Medicare Oscar/Certification
AZ242390Medicaid
CO45826226Medicaid
AK8EZ08BMedicare ID - Type Unspecified
AK8EZ14BMedicare ID - Type Unspecified