Provider Demographics
NPI:1366477051
Name:LANE, PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 BENSDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064
Mailing Address - Country:US
Mailing Address - Phone:830-569-6615
Mailing Address - Fax:830-569-6714
Practice Address - Street 1:1030 BENSDALE ROAD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064
Practice Address - Country:US
Practice Address - Phone:830-569-6615
Practice Address - Fax:830-569-6714
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB116592OtherWELLMED MEDICARE
TX1177792-05OtherWELLMED MEDICAID
TX1177792-05OtherWELLMED MEDICAID