MEDICARE: DR. LANE C. CHILDS MD

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	208800000X	Urology Physician	1869831205	UT

General Provider Information

NPI Number	:	1831239995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LANE C. CHILDS MD

Provider Business Mailing Address
First Line	:	4252 HIGHLAND DR
Second Line	:	#200
City	:	SLC
State	:	UT
Zip	:	84124-2670
Country	:	US
Telephone Number	:	801-993-1800
Fax Number	:	801-993-1699

Provider Business Practice Location Address
First Line	:	4252 HIGHLAND DR
Second Line	:	#200
City	:	SLC
State	:	UT
Zip	:	84124-2670
Country	:	US
Telephone Number	:	801-993-1800
Fax Number	:	801-993-1699

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	03/14/2017

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