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General NPI Number Information
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NPI Number | 1093650806
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Entity Type | Organization
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Legal Business Name | REVIVAL MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 04/20/2026
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Last Update Date | 04/20/2026
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Provider Practice Location Address
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Address Line | 1300 DACY LN BLDG 2 STE. 270
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City | KYLE
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State | TX
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Zip | 78640-4192
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Country | US
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Telephone | 310-745-9935
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Fax |
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Provider Business Mailing Address
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Address Line | 119 CREST VIEW DR
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City | LAKEWAY
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State | TX
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Zip | 78734-5207
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Country | US
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Telephone | 310-745-9935
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALAN LEE LANE
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Credential | MD
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Telephone | 512-757-3259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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