Healthcare Provider Details

I. General information

NPI: 1841275138
Provider Name (Legal Business Name): LANCE A DUVALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

IV. Provider business mailing address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4442
  • Fax: 843-527-4027
Mailing address:
  • Phone: 843-527-4442
  • Fax: 843-527-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8381
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: