MEDICARE: DR. KEVIN B LANE DO

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

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

General Provider Information

NPI Number	:	1619979044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN B LANE DO

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	10/15/2025

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