Individual
LANCE RANDELL SEAGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
01029553A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000592944
ANTHEM PROVIDER NUMBER
IN
05
—
100385510
—
IN
Enumeration date
08/27/2006
Last updated
06/16/2009
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