Basic Information
Provider Information
NPI: 1306133749
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JEPSON
FirstName: LANCE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3011 N MICHIGAN ST
Address2:  
City: PITTSBURG
State: KS
PostalCode: 667622546
CountryCode: US
TelephoneNumber: 6202319873
FaxNumber: 6202312808
Practice Location
Address1: 2025 SE CALIFORNIA AVE
Address2:  
City: TOPEKA
State: KS
PostalCode: 666071443
CountryCode: US
TelephoneNumber: 7858618800
FaxNumber: 7854785991
Other Information
ProviderEnumerationDate: 07/06/2011
LastUpdateDate: 11/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X58. 003953OHN Student, Health CareStudent in an Organized Health Care Education/Training Program 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 
208000000X05-36940KSY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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