MR. EDWARD B LACK MD
NPI 1417955584
Dermatology in Brandon, FL

Active since July 12, 2005
540 MEDICAL OAKS AVE, SUITE 102, BRANDON, FL 33511(813) 651-1991(813) 651-1401 Get Directions Write a Review

NPPES record last updated: November 15, 2016. Verified against the NPPES registry weekly; last sync: September 27, 2026.

About Mr. Edward B Lack Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. EDWARD B LACK MD (NPI 1417955584) is an individual dermatology provider in Brandon, Florida, licensed in Illinois (036-043409) and active in the NPI registry since July 2005.

NPPES Registry Identity

NPI1417955584
Entity TypeIndividualMale
Primary Taxonomy207N00000X
Provider Legal NameMR. EDWARD B LACKCredential: MD
Location Address540 MEDICAL OAKS AVE, SUITE 102Brandon, FL 33511-5995
Mailing Address151 Southhall Ln, Suite 300Maitland, FL 32751-7176 · (407) 875-2080 · Fax (407) 650-3544
Fax(813) 651-1401
Sole ProprietorNo
Enumeration DateJuly 12, 2005
Last NPPES UpdateNovember 15, 2016
✔ NPI 1417955584 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Licenses✔ Licensed in IL · 036-043409✔ Licensed in FL · ME114654
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
540 MEDICAL OAKS AVE, Brandon, FL 33511

Other Identifiers 3

Other0021603804Bcbs
Medicare PINGX723YFL
Medicare PINGX723ZFL

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Ophthalmology
540 MEDICAL OAKS AVE, SUITE 103
BRANDON, FL 33511
Dermatology
540 MEDICAL OAKS AVE, SUITE 102
BRANDON, FL 33511
Ophthalmology
540 MEDICAL OAKS AVE, SUITE 103
BRANDON, FL 33511

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edward Lack's NPI number?

The NPI number for Edward Lack is 1417955584. It was assigned to this individual provider in the NPPES registry on July 12, 2005.

Where is Edward Lack located?

Edward Lack practices at 540 Medical Oaks Ave Suite 102, Brandon, FL 33511. The listed phone number is (813) 651-1991.

What is Edward Lack's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Edward Lack was last updated on November 15, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.