MEDICARE: DR. JASON WILLIAM LANE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME88332	FL
2	207RA0401X	Addiction Medicine (Internal Medicine) Physician	ME88332	FL
3	207RI0200X	Infectious Disease Physician	ME 88332	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790753937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON WILLIAM LANE M.D.

Provider Business Mailing Address
First Line	:	1610 VICTORIA POINTE LN
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33327-1312
Country	:	US
Telephone Number	:	202-297-2525
Fax Number	:

Provider Business Practice Location Address
First Line	:	871 W OAKLAND PARK BLVD
Second Line	:
City	:	WILTON MANORS
State	:	FL
Zip	:	33311-1731
Country	:	US
Telephone Number	:	954-567-7141
Fax Number	:	305-428-8388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/22/2024

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