Provider Demographics
NPI:1447266267
Name:LONGMORE, LANCE SPENCER (DO)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:SPENCER
Last Name:LONGMORE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E CLARK ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-4133
Mailing Address - Country:US
Mailing Address - Phone:208-233-2273
Mailing Address - Fax:208-417-0272
Practice Address - Street 1:1515 E CLARK ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4133
Practice Address - Country:US
Practice Address - Phone:208-233-2273
Practice Address - Fax:208-417-0272
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-0711207R00000X, 207RC0000X, 207UN0901X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology