Healthcare Provider Details

I. General information

NPI: 1639155484
Provider Name (Legal Business Name): CHRIS ALLEN LANE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5350 SPRING HILL DR
SPRING HILL FL
34606-4562
US

IV. Provider business mailing address

5759 N CARNATION DR
BEVERLY HILLS FL
34465-2255
US

V. Phone/Fax

Practice location:
  • Phone: 352-688-8116
  • Fax: 352-686-9477
Mailing address:
  • Phone: 352-746-6141
  • Fax: 353-746-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9103721
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: