Healthcare Provider Details

I. General information

NPI: 1184610701
Provider Name (Legal Business Name): DARII ANN LANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 JEFFERSON AVE
FT EUSTIS VA
23604
US

IV. Provider business mailing address

10010 ROGERS XING
SAN ANTONIO TX
78251-4673
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7500
  • Fax:
Mailing address:
  • Phone: 210-539-0905
  • Fax: 210-521-2574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD28665
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101251019
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: