Provider Demographics
NPI:1275508434
Name:LANCASTER, RODNEY WILLIAM
Entity Type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:WILLIAM
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RODNEY
Other - Middle Name:
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2819 LAKE SILVER RD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-9375
Mailing Address - Country:US
Mailing Address - Phone:850-259-9986
Mailing Address - Fax:850-689-3104
Practice Address - Street 1:2819 LAKE SILVER RD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-9375
Practice Address - Country:US
Practice Address - Phone:850-259-9986
Practice Address - Fax:850-689-3104
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor