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General NPI Number Information
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NPI Number | 1770080533
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Entity Type | Individual
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Provider Name | CODY H LANE DO
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Gender | Male
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 901 KENTON STATION DR
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City | MAYSVILLE
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State | KY
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Zip | 41056-9609
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Country | US
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Telephone | 606-759-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 405 W GRAND AVE
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City | DAYTON
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State | OH
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Zip | 45405-7538
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Country | US
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Telephone | 937-723-3245
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 05430
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License Number State | KY
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