Provider Demographics
NPI:1104147990
Name:MARTIN, LANCE (MD)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-2438
Mailing Address - Country:US
Mailing Address - Phone:806-796-0507
Mailing Address - Fax:806-799-6908
Practice Address - Street 1:207 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-5811
Practice Address - Fax:432-758-4740
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP5551207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine