Provider Demographics
NPI:1568442184
Name:LANE, BRIAN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:FRANCIS
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S BOND AVE # CH6D
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4501
Mailing Address - Country:US
Mailing Address - Phone:503-494-1983
Mailing Address - Fax:
Practice Address - Street 1:3303 S BOND AVE # CH6D
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-1983
Practice Address - Fax:503-418-3683
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN58639208600000X
ORMD214459208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2510018Medicaid
OH2510018Medicaid
OHG78586Medicare UPIN
0843507Medicare PIN