Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | MD00016319 | WA |
NPI | 1053389551 |
---|---|
Provider Name | Dr. Robert Lane |
First Address | Seattle, WA 98133-8414 |
Second Address | Seattle, WA 98133-8414 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1066158 | (05) | WA |
A04960 | (02) | WA |