Organization
STAYTON FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE B LARGE MD (OWNER)
(503) 769-2641
Entity
Organization
Contact information
Practice address
1375 N 10TH AVE, STAYTON, OR 97383-2037
(503) 769-2641
(503) 769-3797
Mailing address
1375 N 10TH AVE, STAYTON, OR 97383-2037
(503) 769-2641
(503) 769-3797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/24/2008
Last updated
08/25/2009
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