Provider Demographics
NPI:1306206560
Name:RILEY, GUY LANE
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:LANE
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 N RIVER DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-4306
Mailing Address - Country:US
Mailing Address - Phone:432-557-2735
Mailing Address - Fax:
Practice Address - Street 1:1706 N RIVER DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4306
Practice Address - Country:US
Practice Address - Phone:432-557-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications