Provider Demographics
NPI:1548244684
Name:LANE, WILL HARLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:WILL
Middle Name:HARLEY
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-932-6330
Mailing Address - Fax:925-932-0139
Practice Address - Street 1:2637 SHADELANDS DR
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2512
Practice Address - Country:US
Practice Address - Phone:925-932-6330
Practice Address - Fax:925-932-0139
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2018-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG30683207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G306830OtherCA LICENSE
CAA44512Medicare UPIN
CA942514541OtherFED TAX ID