Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0523666 | KS |
NPI | 1003913310 |
---|---|
Provider Name | Gerald E. Lane |
First Address | Liberal, KS 67901-2055 |
Second Address | Liberal, KS 67901-2055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 20/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F29364 | (02) | KS |