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General NPI Number Information
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NPI Number | 1720312168
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Entity Type | Individual
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Provider Name | JOHN ANTHONY LANE P.A.
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Gender | Male
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 2149 VALLEYGATE DR STE 201
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3668
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Country | US
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Telephone | 910-728-4410
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CASTLEBAY DR
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City | SANFORD
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State | NC
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Zip | 27332-6272
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Country | US
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Telephone | 910-725-9256
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-08114
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License Number State | NC
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