Provider Demographics
NPI:1285777698
Name:LURIA, LANCE (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:LURIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3265 S NATIONAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7304
Mailing Address - Country:US
Mailing Address - Phone:417-820-6452
Mailing Address - Fax:417-820-8713
Practice Address - Street 1:3265 S NATIONAL AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-820-6452
Practice Address - Fax:417-820-8713
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2010-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO108312207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO160553OtherMO BLUE SHIELD
MO208926915Medicaid
AR98574OtherARK BLUE SHIELD
B82850Medicare UPIN
MO348013268Medicare PIN
MO208926915Medicaid