Healthcare Provider Details

I. General information

NPI: 1386806727
Provider Name (Legal Business Name): SARA K LANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9260 ESTERO PARK COMMONS BLVD STE 100
ESTERO FL
33928-6468
US

IV. Provider business mailing address

9260 ESTERO PARK COMMONS BLVD STE 100
ESTERO FL
33928-6468
US

V. Phone/Fax

Practice location:
  • Phone: 239-908-3593
  • Fax: 239-908-3597
Mailing address:
  • Phone: 239-908-3593
  • Fax: 239-908-3597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 111008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: