Provider Demographics
NPI:1962509414
Name:FERAY, LANCE MARK (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:MARK
Last Name:FERAY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 DOWCREST
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389
Mailing Address - Country:US
Mailing Address - Phone:281-655-7155
Mailing Address - Fax:
Practice Address - Street 1:720 LAWRENCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6455
Practice Address - Country:US
Practice Address - Phone:281-351-5922
Practice Address - Fax:281-255-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG35950Medicare UPIN
TX89621JMedicare ID - Type Unspecified