MEDICARE: TIMOTHY PALMER LANE PA-C

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	363A00000X	Physician Assistant		AZ

General Provider Information

NPI Number	:	1144776113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY PALMER LANE PA-C

Provider Business Mailing Address
First Line	:	3330 N 2ND ST STE 401
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2371
Country	:	US
Telephone Number	:	602-606-8949
Fax Number	:	602-759-7409

Provider Business Practice Location Address
First Line	:	3330 N 2ND ST STE 401
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-2371
Country	:	US
Telephone Number	:	602-606-8949
Fax Number	:	602-759-7409

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

Provider Enumeration Date	:	08/30/2016
Last Update Date	:	11/18/2025

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