Basic Information
Provider Information
NPI: 1962503581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLGOWER
FirstName: LANCE
MiddleName: F
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9229 LBJ FWY
Address2: STE 250
City: DALLAS
State: TX
PostalCode: 752433405
CountryCode: US
TelephoneNumber: 8003460747
FaxNumber: 9727392638
Practice Location
Address1: 3100 N TENAYA WAY
Address2:  
City: LAS VEGAS
State: NV
PostalCode: 891280436
CountryCode: US
TelephoneNumber: 9729153600
FaxNumber: 9729153636
Other Information
ProviderEnumerationDate: 09/26/2006
LastUpdateDate: 07/26/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X1063NVY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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