Provider Demographics
NPI:1902891260
Name:DOZIER, LANCE C (MD)
Entity Type:Individual
Prefix:MR
First Name:LANCE
Middle Name:C
Last Name:DOZIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1205
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-0912
Mailing Address - Country:US
Mailing Address - Phone:276-679-0800
Mailing Address - Fax:276-679-1261
Practice Address - Street 1:338 COEBURN AVE SW
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-2606
Practice Address - Country:US
Practice Address - Phone:276-679-0800
Practice Address - Fax:276-679-1261
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035554208600000X
KY23058208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64230584Medicaid
VA007300212Medicaid
KY1488801Medicare PIN
VA007300212Medicaid
VA00W345L01Medicare PIN
KY64230584Medicaid
C78523Medicare UPIN