Provider Demographics
NPI:1225063647
Name:LANE, CHRISTOPHER ALAN (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:ALAN
Last Name:LANE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258887
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-8887
Mailing Address - Country:US
Mailing Address - Phone:405-470-6767
Mailing Address - Fax:405-470-6768
Practice Address - Street 1:310 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5572
Practice Address - Country:US
Practice Address - Phone:620-275-9752
Practice Address - Fax:620-275-4306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-46905207V00000X
OK3863207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200057270AMedicaid
OK249631005Medicare PIN
OKI37449Medicare UPIN