Provider Demographics
NPI:1386857761
Name:ASHWORTH, LANCE DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DEAN
Last Name:ASHWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1048 SHOCKNEY DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3325
Mailing Address - Country:US
Mailing Address - Phone:386-275-5911
Mailing Address - Fax:
Practice Address - Street 1:73 W GRANADA BLVD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-6302
Practice Address - Country:US
Practice Address - Phone:386-672-0220
Practice Address - Fax:386-672-0105
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8753208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice