Provider Demographics
NPI:1003913310
Name:LANE, GERALD E (DO)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:E
Last Name:LANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2381 NORTH KANSAS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2055
Mailing Address - Country:US
Mailing Address - Phone:620-624-7900
Mailing Address - Fax:620-624-6001
Practice Address - Street 1:2381 NORTH KANSAS AVENUE
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2055
Practice Address - Country:US
Practice Address - Phone:620-624-7900
Practice Address - Fax:620-624-6001
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0523666207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSF29364Medicare UPIN