Healthcare Provider Details

I. General information

NPI: 1053389551
Provider Name (Legal Business Name): ROBERT LANE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 N 115TH ST G - 16
SEATTLE WA
98133-8414
US

IV. Provider business mailing address

1560 N 115TH ST G - 16
SEATTLE WA
98133-8414
US

V. Phone/Fax

Practice location:
  • Phone: 206-365-8252
  • Fax: 206-365-6136
Mailing address:
  • Phone: 206-365-8252
  • Fax: 206-365-6136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD00016319
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: