Provider Demographics
NPI:1528599545
Name:BLOCK, LANE
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:
Last Name:BLOCK
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 1:2645 NALL ST
Mailing Address - Street 2:
Mailing Address - City:PORT NECHES
Mailing Address - State:TX
Mailing Address - Zip Code:77651-4707
Mailing Address - Country:US
Mailing Address - Phone:409-210-3336
Mailing Address - Fax:409-527-3969
Practice Address - Street 1:2645 NALL ST
Practice Address - Street 2:
Practice Address - City:PORT NECHES
Practice Address - State:TX
Practice Address - Zip Code:77651-4707
Practice Address - Country:US
Practice Address - Phone:409-210-3336
Practice Address - Fax:409-527-3969
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other