Doctor Name: | BRETT JACK LANCASTER |
NPI Number: | 1619296605 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.M.D |
License Number: | |
Business Practice Address: | 1361 E 16th St #2 Burley, ID - 833182008 |
Business Phone Number: | 2086775198 |
Business Fax Number: | 2086782245 |
Mailing Address: | 794 Eastland Dr, TWIN FALLS |
State: | ID |
Postal Code: | 833016856 |
Phone Number: | 2087343312 |
Fax Number: | 2087345036 |
NPI Enumeration Date: | 05/31/2010 |
NPI Last Update Date: | 12/10/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |