Individual
VANCE R LASSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23020 M RD, HOLTON, KS 66436-8641
(785) 362-8677
(785) 362-4372
Mailing address
23020 M RD, HOLTON, KS 66436-8641
(785) 362-8677
(785) 362-4372
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0431904
KS
207Q00000X
Family Medicine Physician
6104
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103826
BLUE CROSS/BLUE SHIELD
KS
01
—
106429
MEDICARE ID UNSPECIFIED
KS
05
—
200441800A
—
KS
Enumeration date
02/23/2006
Last updated
03/23/2021
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