Individual
LANCE BRANDON LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1375 N 10TH AVE, STAYTON, OR 97383-2099
(503) 769-2641
(503) 769-3797
Mailing address
1375 N 10TH AVE, STAYTON, OR 97383-2099
(503) 769-2641
(503) 769-3797
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2310
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023015
—
OR
Enumeration date
11/08/2005
Last updated
03/04/2014
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