Healthcare Provider Details

I. General information

NPI: 1912955147
Provider Name (Legal Business Name): THOMAS H LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 WHETSTONE ST
MONROEVILLE AL
36460-2625
US

IV. Provider business mailing address

129 WHETSTONE ST
MONROEVILLE AL
36460-2625
US

V. Phone/Fax

Practice location:
  • Phone: 251-575-3939
  • Fax: 251-575-2379
Mailing address:
  • Phone: 251-575-3939
  • Fax: 251-575-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number00009879
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: