Provider Demographics
NPI:1831150812
Name:LANCE, BILLY J (MD)
Entity type:Individual
Prefix:DR
First Name:BILLY
Middle Name:J
Last Name:LANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2623
Mailing Address - Country:US
Mailing Address - Phone:803-799-8407
Mailing Address - Fax:803-376-1163
Practice Address - Street 1:CAROLINA MEDICAL GROUP 3010 FARROW ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-799-1264
Practice Address - Fax:803-376-1163
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7131Medicaid
WI421841Medicare ID - Type Unspecified
WI421832Medicare ID - Type Unspecified
SC7131Medicaid
SCD05519Medicare UPIN