MEDICARE: DR. LANCE DAVID REAL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS18314	FL
2	207Q00000X	Family Medicine Physician	036122796	IL

General Provider Information

NPI Number	:	1497733091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCE DAVID REAL D.O.

Provider Business Mailing Address
First Line	:	2995 DREW ST
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-3012
Country	:	US
Telephone Number	:	727-315-7496
Fax Number	:

Provider Business Practice Location Address
First Line	:	5617 SKYTOP DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-4165
Country	:	US
Telephone Number	:	813-530-4585
Fax Number	:	813-605-6053

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	06/18/2024

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Directions to “ DR. LANCE DAVID REAL D.O.” Practice Location

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