MEDICARE: KEVIN LANE DO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	L8579	TX

General Provider Information

NPI Number	:	1003001579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KEVIN LANE DO PA

Provider Business Mailing Address
First Line	:	4103 WILBARGER ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3137
Country	:	US
Telephone Number	:	940-553-2140
Fax Number	:	940-553-1739

Provider Business Practice Location Address
First Line	:	4103 WILBARGER ST
Second Line	:
City	:	VERNON
State	:	TX
Zip	:	76384-3137
Country	:	US
Telephone Number	:	940-553-2140
Fax Number	:	940-553-1739

Authorized Official
Title or Position	:	DO
Name	:	KEVIN B LANE
Credential	:
Telephone Number	:	940-553-2140

Provider Enumeration Date	:	09/07/2007
Last Update Date	:	10/15/2025

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Directions to “KEVIN LANE DO PA ” Practice Location

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