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General NPI Number Information
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NPI Number | 1194879981
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Entity Type | Individual
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Provider Name | ALFRED THOMAS LANE MD
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Gender | Male
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 BLAKE WILBUR DR. W0071
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City | STANFORD
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State | CA
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Zip | 94305-5334
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Country | US
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Telephone | 650-723-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 1018 LOMA PRIETA CT
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City | LOS ALTOS
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State | CA
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Zip | 94024-5024
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Country | US
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Telephone | 650-960-1354
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A26128
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License Number State | CA
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