Provider Demographics
NPI:1467462101
Name:LANCE, SCOTT JEROME (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JEROME
Last Name:LANCE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ASHLAND DR
Mailing Address - Street 2:P.O. BOX 1447
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7058
Mailing Address - Country:US
Mailing Address - Phone:606-326-0322
Mailing Address - Fax:606-326-9809
Practice Address - Street 1:2000 ASHLAND DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7058
Practice Address - Country:US
Practice Address - Phone:606-326-0322
Practice Address - Fax:606-326-9809
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY322712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000189139OtherANTHEM 12 DIGIT NUMBER
KY64031826Medicaid
OH2245841Medicaid
H10872Medicare UPIN
KY64031826Medicaid