Healthcare Provider Details

I. General information

NPI: 1407176050
Provider Name (Legal Business Name): DARRYL WAYNE LANCING CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2010
Last Update Date: 06/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W END AVE STE 800
NASHVILLE TN
37203-1378
US

IV. Provider business mailing address

178 S BIRCHWOOD ST
ANAHEIM CA
92808-1203
US

V. Phone/Fax

Practice location:
  • Phone: 877-345-5595
  • Fax:
Mailing address:
  • Phone: 972-757-3272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: