Provider Demographics
NPI:1295729853
Name:LANCASTER, BOBBI D (MD)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:D
Last Name:LANCASTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:DOUGLAS
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2421 S RAINBOWS END
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85218
Mailing Address - Country:US
Mailing Address - Phone:480-982-4431
Mailing Address - Fax:480-671-0140
Practice Address - Street 1:2421 S RAINBOWS END
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85218
Practice Address - Country:US
Practice Address - Phone:480-982-4431
Practice Address - Fax:480-671-0140
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20188207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ063735Medicaid
AZE95194Medicare UPIN
AZ84026Medicare ID - Type Unspecified