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Individual

LANCE ROGER OLDORF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1026 A AVE NE, CEDAR RAPIDS, IA 52402-5036
(319) 369-7451
Mailing address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
109718
IA
363A00000X
Physician Assistant
2099
TN
363A00000X
Physician Assistant
PA.1011
AL

Other

Enumeration date
06/04/2009
Last updated
05/02/2022
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