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Individual

PAUL ANTHONY LACEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
17 S WESTERN AVE, TONASKET, WA 98855-9270
(509) 486-2174
Mailing address
820 N CHELAN AVE, WENATCHEE, WA 98801-2028
(509) 663-8711

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD60222862
WA
207Q00000X
Family Medicine Physician
MR-0981
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0284414
L&I
WA
05
1275793804
WA
01
MR-0981
BOARD OF MEDICINE
ID
Enumeration date
06/17/2008
Last updated
06/28/2022
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