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:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245303429 | NPPES |
| Washington | MEDICAID | 8232787 |
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