Provider Demographics
NPI:1679678320
Name:LANCE, SCOT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:EDWARD
Last Name:LANCE
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 1:1749 LINCOLN PARK CIR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-8446
Mailing Address - Country:US
Mailing Address - Phone:941-350-9855
Mailing Address - Fax:
Practice Address - Street 1:1749 LINCOLN PARK CIR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-8446
Practice Address - Country:US
Practice Address - Phone:941-350-9855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58997207W00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09398Medicare UPIN
11668Medicare ID - Type Unspecified