Healthcare Provider Details

I. General information

NPI: 1477861672
Provider Name (Legal Business Name): SCOT E LANCE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST SUITE 801
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

1921 WALDEMERE ST SUITE 801
SARASOTA FL
34239-2943
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-2345
  • Fax: 941-917-2350
Mailing address:
  • Phone: 941-917-2345
  • Fax: 941-917-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOT E LANCE
Title or Position: OWNER
Credential: MD
Phone: 941-917-2345