Basic Information
| Provider Information | |||||||||
| NPI: | 1003015454 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONTEAU | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2223 E ROSSER AVE | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014949 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018578000 | ||||||||
| FaxNumber: | 7018578070 | ||||||||
| Practice Location | |||||||||
| Address1: | 1290 WONDER WORLD DR STE 1100 | ||||||||
| Address2: | |||||||||
| City: | SAN MARCOS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786667969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123933325 | ||||||||
| FaxNumber: | 5123933328 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2007 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 11622 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 15424 | 05 | ND | MEDICAID |