MEDICARE: DR. MARY LYNN PEPINE M.D.

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	207NS0135X	Procedural Dermatology Physician	ME67049	FL

General Provider Information

NPI Number	:	1518965672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LYNN PEPINE M.D.

Provider Business Mailing Address
First Line	:	727 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5232
Country	:	US
Telephone Number	:	863-687-2055
Fax Number	:	863-687-2155

Provider Business Practice Location Address
First Line	:	727 S FLORIDA AVE
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33801-5232
Country	:	US
Telephone Number	:	863-687-2055
Fax Number	:	863-687-2155

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/26/2012

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