Lack, Edward B

Lack, Edward B is an individual health care provider with primary practice located at 540 Medical Oaks Ave Suite 102, Brandon FL 33511-5995. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Lack, Edward B can be contacted via phone (813) 651-1991.

Contact Information

Primary practice address
540 Medical Oaks Ave Suite 102 Brandon FL 33511-5995
Phone: (813) 651-1991
Fax: (813) 651-1401
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X 036-043409 Illinois
Allopathic & Osteopathic Physicians / Dermatology 207N00000X ME114654 Florida

Profile Details

NPI number 1417955584
LBN Legal business name Lack, Edward B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 12th, 2005
Last updated Nov 15th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417955584 NPPES
Other 0021603804 BCBS

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