Provider Demographics
NPI:1134801392
Name:HARE, LANCE
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:HARE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 BLODGETT ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-5192
Mailing Address - Country:US
Mailing Address - Phone:304-692-3690
Mailing Address - Fax:
Practice Address - Street 1:2223 ROLLINGBROOK DR UNIT 125
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3656
Practice Address - Country:US
Practice Address - Phone:281-420-3565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA19368363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant