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General NPI Number Information
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NPI Number | 1295319861
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Entity Type | Individual
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Provider Name | CAROLINE ROGERS LANE MD
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Gender | Female
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Dates
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Enumeration Date | 05/10/2021
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 4284 KELSON AVE
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City | MARIANNA
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State | FL
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Zip | 32446-2948
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Country | US
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Telephone | 850-482-2910
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Fax | 850-526-2138
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Provider Business Mailing Address
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Address Line | 2000 E GREENVILLE ST STE 3700
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City | ANDERSON
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State | SC
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Zip | 29621-1725
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME176199
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License Number State | FL
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