Provider Demographics
NPI:1437143104
Name:MEYERSON, LANCE R (MD)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:R
Last Name:MEYERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:38135 MARKET SQ
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7505
Mailing Address - Country:US
Mailing Address - Phone:352-567-0188
Mailing Address - Fax:813-355-5101
Practice Address - Street 1:12500 N DALE MABRY HWY STE F
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2809
Practice Address - Country:US
Practice Address - Phone:813-907-9992
Practice Address - Fax:813-355-5034
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2021-08-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME70699207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00625641OtherRR MEDICARE
FL251417600Medicaid
FL251417600Medicaid