Individual
GILLES LACHANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
807 S PONDEROSA ST, PAYSON, AZ 85541-5542
(928) 474-5729
(928) 472-8205
Mailing address
9250 N 3RD ST, SUITE 4010, PHOENIX, AZ 85020-2437
(602) 633-3848
(602) 633-3841
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
31601
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
779316
AHCCCS
AZ
05
—
779316
—
AZ
Enumeration date
09/14/2005
Last updated
03/25/2015
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