Individual
LANCE W MCKAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
1151 HOSPITAL WAY, BLD D, POCATELLO, ID 83201-5091
(208) 239-8010
(208) 782-2974
Mailing address
1151 HOSPITAL WAY, BLD D, POCATELLO, ID 83201-5091
(208) 239-8010
(208) 782-2974
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA-1071
ID
363AS0400X
Surgical Physician Assistant
Primary
PA-1071
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3Z5047
HEALTHNET
AZ
05
—
611187
—
AZ
Enumeration date
04/27/2011
Last updated
12/16/2013
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