MEDICARE: LANE LESTER SMOTHERS 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
1	208600000X	Surgery Physician	6580A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	308892	OTHER	WY	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043206485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANE LESTER SMOTHERS M.D.

Provider Business Mailing Address
First Line	:	419 S WASHINGTON ST
Second Line	:	SUITE 102
City	:	CASPER
State	:	WY
Zip	:	82601-2951
Country	:	US
Telephone Number	:	307-577-4220
Fax Number	:	307-235-0931

Provider Business Practice Location Address
First Line	:	419 S WASHINGTON ST
Second Line	:	SUITE 102
City	:	CASPER
State	:	WY
Zip	:	82601-2951
Country	:	US
Telephone Number	:	307-577-4220
Fax Number	:	307-235-0931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	07/09/2007

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Directions to “ LANE LESTER SMOTHERS M.D.” Practice Location

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