Individual
BRENT W. LACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 BREWSTER BLVD, CAMP LEJEUNE, NC 28547-2575
(910) 450-3841
(910) 450-3463
Mailing address
4828 N DAVIS HWY, PENSACOLA, FL 32503-2341
(850) 477-8109
(850) 478-2412
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
ME124361
FL
207RG0100X
Gastroenterology Physician
Primary
N8314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017169900
—
FL
01
—
4X7W3
BCBS
FL
01
—
IO214Z
MCR
FL
Enumeration date
06/16/2009
Last updated
06/10/2020
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