Individual
VAN L LACKEY
Active
Individual
VAN L LACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
06430
MS
207RX0202X
Medical Oncology Physician
Primary
06430
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115429
—
MS
05
—
1541575
—
LA
01
—
4285654
AETNA HEALTHCARE
—
Enumeration date
06/10/2005
Last updated
06/18/2010
Update your record
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