Provider Demographics
NPI:1407819584
Name:LANE, JUDY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:C
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 CROWN CREST BLVD, #200
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138
Mailing Address - Country:US
Mailing Address - Phone:303-840-5051
Mailing Address - Fax:303-840-5058
Practice Address - Street 1:333 WEST HAMPDEN AVE,
Practice Address - Street 2:SUITE 310
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110
Practice Address - Country:US
Practice Address - Phone:303-781-5505
Practice Address - Fax:303-788-4220
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30759174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE90513Medicare UPIN