Provider Demographics
NPI:1023163011
Name:MAYOR, LANCE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DAVID
Last Name:MAYOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3061 S MARYLAND PKWY STE 103
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-6226
Mailing Address - Country:US
Mailing Address - Phone:702-438-5555
Mailing Address - Fax:702-438-6666
Practice Address - Street 1:3061 S MARYLAND PKWY STE 104
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-6226
Practice Address - Country:US
Practice Address - Phone:702-438-5555
Practice Address - Fax:702-438-6666
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2022-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV3943207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002341Medicaid
NVC96321Medicare UPIN