Provider Demographics
NPI:1114979440
Name:LANE, DAVID L (M,D)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:LANE
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:197 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-4347
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3507
Practice Address - Street 1:BUILDING 160 DOGWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3507
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD11896207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000011896OtherSTATE LICENSE
VA0101028936OtherSTATE LICENSE
TNMD0000011896OtherSTATE LICENSE