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General NPI Number Information
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NPI Number | 1891098760
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Entity Type | Organization
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Legal Business Name | LANCE D MAYOR, MD LTD
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 2121 E FLAMINGO RD 202
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City | LAS VEGAS
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State | NV
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Zip | 89119-5122
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Country | US
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Telephone | 702-369-0004
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Fax | 702-369-6488
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Provider Business Mailing Address
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Address Line | 2121 E FLAMINGO RD 202
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City | LAS VEGAS
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State | NV
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Zip | 89119-5122
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Country | US
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Telephone | 702-369-0004
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Fax | 702-369-6488
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Authorized Official
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Title or Position | OWNER
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Name | LANCE D MAYOR
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Credential | MD
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Telephone | 702-369-0004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 3943
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License Number State | NV
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