Provider Demographics
NPI:1083661441
Name:KREPLICK, LANCE (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:KREPLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11339 HAWKS FERN DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5714
Mailing Address - Country:US
Mailing Address - Phone:813-361-1096
Mailing Address - Fax:
Practice Address - Street 1:11339 HAWKS FERN DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5714
Practice Address - Country:US
Practice Address - Phone:813-361-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72056207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251254800Medicaid
FL21010OtherBCBS FL
FL251254800Medicaid
E97666Medicare UPIN