Healthcare Provider Details

I. General information

NPI: 1053312249
Provider Name (Legal Business Name): DAVID ALLEN LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE ROAD HEADQUARTERS UNIT, TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859-5000
US

IV. Provider business mailing address

1 JARRETT WHITE ROAD HEADQUARTERS UNIT, TRIPLER ARMY MEDICAL CENTER
HONOLULU HI
96859-5000
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-5781
  • Fax:
Mailing address:
  • Phone: 808-433-5781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberMD-051174-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-051174-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: