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NPI Code Detail

MEDICARE: DR. WESLEY GARRETT LANE M.D.

MEDICARE: DR. WESLEY GARRETT LANE M.D.
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
1207R00000XInternal Medicine PhysicianBP10043544TX
2207RC0000XCardiovascular Disease PhysicianE12014AR

General Provider Information

NPI Number : 1013276187
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WESLEY GARRETT LANE M.D.
Provider Business Mailing Address
First Line : 2623 MEADOW WOOD DR
Second Line :
City : TEMPLE
State : TX
Zip : 76502-7916
Country : US
Telephone Number : 806-789-8452
Fax Number :
Provider Business Practice Location Address
First Line : 7 SHACKLEFORD WEST BLVD
Second Line :
City : LITTLE ROCK
State : AR
Zip : 72211-3886
Country : US
Telephone Number : 501-664-5860
Fax Number : 501-664-0889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2012
Last Update Date : 08/21/2019

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