Individual
MR. RUSSELL GUY LANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2010 OLD GREENBRIER RD STE B, CHESAPEAKE, VA 23320-2619
(757) 361-6634
(757) 361-6635
Mailing address
2213 HUNTERS WOOD WAY, VIRGINIA BEACH, VA 23454-2103
(757) 650-9477
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110000082
VA
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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