Provider Demographics
NPI:1538790886
Name:TAYLOR, LANCE SHANE
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:SHANE
Last Name:TAYLOR
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 1:521 DUDLEY DR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-5023
Mailing Address - Country:US
Mailing Address - Phone:318-265-7562
Mailing Address - Fax:
Practice Address - Street 1:521 DUDLEY DR
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-5023
Practice Address - Country:US
Practice Address - Phone:318-265-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator