=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588542393
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SETH GREGORY LAPE
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10423 CENTURION PKWY N
-----------------------------------------------------
City | JACKSONVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32256-0527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 904-854-2090
-----------------------------------------------------
Fax | 904-854-2093
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 96 BLIND OAK CIR
-----------------------------------------------------
City | ST AUGUSTINE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32095-0151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-754-5856
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156F00000X
-----------------------------------------------------
Taxonomy Name | Technician/Technologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------