Petersen, Lance

Petersen, Lance is an individual health care provider with primary practice located at 777 Avenue H , Powell WY 82435-2260. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Petersen, Lance can be contacted via phone (307) 754-2267.

Contact Information

Primary practice address
777 Avenue H Powell WY 82435-2260
Phone: (307) 754-2267
Fax: (307) 754-7747
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 8006A Wyoming
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X MD00035749 Washington

Profile Details

NPI number 1245303429
LBN Legal business name Petersen, Lance
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 16th, 2006
Last updated Oct 23rd, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1245303429 NPPES
Washington MEDICAID 8232787

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