MEDICARE: DR. LANCE DAVIS MD

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	207ZF0201X	Forensic Pathology Physician	ME66524	FL

General Provider Information

NPI Number	:	1619227709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANCE DAVIS MD

Provider Business Mailing Address
First Line	:	5301 SW 31ST AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-6906
Country	:	US
Telephone Number	:	954-357-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	5301 SW 31ST AVE
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33312-6906
Country	:	US
Telephone Number	:	954-357-5215
Fax Number	:

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

Provider Enumeration Date	:	09/15/2012
Last Update Date	:	09/15/2012

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