Healthcare Provider Details

I. General information

NPI: 1093650806
Provider Name (Legal Business Name): REVIVAL MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 DACY LN BLDG 2 STE. 270
KYLE TX
78640-4192
US

IV. Provider business mailing address

119 CREST VIEW DR
LAKEWAY TX
78734-5207
US

V. Phone/Fax

Practice location:
  • Phone: 310-745-9935
  • Fax:
Mailing address:
  • Phone: 310-745-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN LEE LANE
Title or Position: OWNER
Credential: MD
Phone: 512-757-3259