| Mr Edward B Lack, MD | |
|
540 Medical Oaks Ave, Suite 102, Brandon, FL 33511-5995 | |
| (813) 651-1991 | |
| (813) 651-1401 |
| Full Name | Mr Edward B Lack |
|---|---|
| Gender | Male |
| Speciality | Dermatology |
| Location | 540 Medical Oaks Ave, Brandon, Florida |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417955584 | NPI | - | NPPES |
| 0021603804 | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207N00000X | Dermatology | 036-043409 (Illinois) | Primary |
| 207N00000X | Dermatology | ME114654 (Florida) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Edward B Lack, MD 151 Southhall Ln, Suite 300, Maitland, FL 32751-7176 Ph: (407) 875-2080 | Mr Edward B Lack, MD 540 Medical Oaks Ave, Suite 102, Brandon, FL 33511-5995 Ph: (813) 651-1991 |
Dr. Sanjay Agarwal, DO Dermatology Medicare: Medicare Enrolled Practice Location: 405 W Bloomingdale Ave, Brandon, FL 33511 Phone: 813-662-3376 | |
Jerry Leo Hedrick, MD Dermatology Medicare: Accepting Medicare Assignments Practice Location: 500 Vonderburg Drive, Ste 115w, Brandon, FL 33511 Phone: 813-685-0306 Fax: 813-651-1026 | |
Dr. Nancy S Ling, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 305 Bryan Rd, Suite 5 & 6, Brandon, FL 33511 Phone: 813-689-2054 Fax: 813-654-5640 | |
Dr. Kathleen M Colorado, M.D. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 507 Oakfield Dr, Brandon, FL 33511 Phone: 813-661-6667 | |
Dr. Brittany Erin Hearn, D.O. Dermatology Medicare: Accepting Medicare Assignments Practice Location: 621 Medical Care Dr, Brandon, FL 33511 Phone: 813-657-3330 Fax: 813-657-3348 | |
Dr. Susan Lynn Malane, D.O. Dermatology Medicare: Not Enrolled in Medicare Practice Location: 116 S Montclair Ave, Brandon, FL 33511 Phone: 813-685-7714 Fax: 813-685-0113 |