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General NPI Number Information
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NPI Number | 1497733091
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Entity Type | Individual
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Provider Name | LANCE DAVID REAL D.O.
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 06/18/2024
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Provider Practice Location Address
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Address Line | 5617 SKYTOP DR
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City | LITHIA
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State | FL
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Zip | 33547-4165
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Country | US
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Telephone | 813-530-4585
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Fax | 813-605-6053
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Provider Business Mailing Address
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Address Line | 2995 DREW ST
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City | CLEARWATER
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State | FL
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Zip | 33759-3012
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Country | US
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Telephone | 727-315-7496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS18314
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036122796
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License Number State | IL
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