Healthcare Provider Details

I. General information

NPI: 1598736779
Provider Name (Legal Business Name): CHRISTOPHER TROY LANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE SUITE 109
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

999 N TUSTIN AVE SUITE 109
SANTA ANA CA
92705-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-954-1182
  • Fax: 714-953-3425
Mailing address:
  • Phone: 714-954-1182
  • Fax: 714-953-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA61513
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA61513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: