Provider Demographics
NPI:1003903584
Name:LANCE, CHRISTIAN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:ANN
Last Name:LANCE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 412
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2618
Mailing Address - Country:US
Mailing Address - Phone:817-662-2006
Mailing Address - Fax:817-623-9598
Practice Address - Street 1:800 8TH AVE STE 412
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2618
Practice Address - Country:US
Practice Address - Phone:817-662-2006
Practice Address - Fax:817-623-9598
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5316207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C0132OtherBCBSTX
TX186935601Medicaid
TXP00722625Medicare PIN
TXI70219Medicare UPIN
TX8J2814Medicare PIN