Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MR. EDWARD B LACK, MD
ActiveMR. EDWARD B LACK, MD is a Dermatology healthcare provider located in BRANDON, Florida. NPI 1417955584 is currently active in the NPPES registry. Verify at CMS.
Dermatology · BRANDON, FL
Registration Details
- NPI Number
- 1417955584
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 12, 2005 (21.058076994395 yrs)
- Last Updated
- Nov 15, 2016
- Licenses
-
036-043409 (IL)ME114654 (FL)
Practice Information
- Address
-
540 MEDICAL OAKS AVESUITE 102BRANDON, FL, 335115995Browse FL providers · Browse ZIP 33511
- Phone
- 8136511991
- Fax
- 8136511401
- Primary Specialty
-
Dermatology
207N00000X
- Additional Specialty
- Dermatology
Other Dermatology Providers in BRANDON, FL
| Name | Credential | NPI |
|---|---|---|
| DR. SUSAN LYNN MALANE | D.O. | 1578556387 |
| DR. KATHLEEN M COLORADO | M.D. | 1336137694 |
| DR. NANCY S LING | M.D. | 1174586481 |
| KATHYLEEN VOLPE HEDRICK | MS ARNP | 1437184785 |
| JERRY LEO HEDRICK | MD | 1164457412 |
| MICHAEL D. THARP | MD | 1699785295 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.