Lance Lane PA-C

NPI 1023088655 - Physician Assistant - 363AM0700X

NPI Details
NPI 1023088655
Gender Male
Enumeration Date 01/25/2006
Last Updated 03/20/2014
Entity Type Individual
Active Over 10 years ago
Practice Location
3701 MEMORIAL DR
BELLEVILLE IL, 62226-5412, US
Phone (618) 222-0000
Fax (618) 222-9329
Business Location
3701 MEMORIAL DR
BELLEVILLE IL, 62226-5412, US
Phone (618) 222-0000
Fax (618) 222-9329
Toxanomy
Taxonomy Code 363AM0700X
License State Illinois
License Number 085001883
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According to our database, Lance Lane PA-C NPI is 1023088655, taxonomy code is 363AM0700X and license number is 085001883, license state is located at Illinois. Lance Lane PA-C physically located at 3701 Memorial Dr, Belleville IL, 62226-5412. NPI Number Lance Lane PA-C has the Individual type.

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1023088655 NPI number is provided on an as is basis without warranty of any kind. 1023088655 is maintained by the National Plan & Provider Enumeration System. The contents of Lance Lane PA-C are for informational purposes only.