Provider Demographics
NPI:1295729671
Name:LEE, LANCE L (DOM)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:L
Last Name:LEE
Suffix:
Gender:M
Credentials:DOM
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 2947
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-2947
Mailing Address - Country:US
Mailing Address - Phone:505-392-2712
Mailing Address - Fax:505-392-2743
Practice Address - Street 1:2800 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1806
Practice Address - Country:US
Practice Address - Phone:505-392-2712
Practice Address - Fax:505-392-2743
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM693171100000X
TXAC00484171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist