Provider Demographics
NPI:1053684191
Name:SECOND LOOK PATHOLOGY, LLC
Entity Type:Organization
Organization Name:SECOND LOOK PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND LABORATORY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DURAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-554-4064
Mailing Address - Street 1:5445 MATTHEW CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-6355
Mailing Address - Country:US
Mailing Address - Phone:941-554-4064
Mailing Address - Fax:941-554-4064
Practice Address - Street 1:5445 MATTHEW CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-6355
Practice Address - Country:US
Practice Address - Phone:941-554-4064
Practice Address - Fax:941-554-4064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory