Provider Demographics
NPI:1578539482
Name:LANE, JOEL ROBIN (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:ROBIN
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7450 KESSLER ST STE 140
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2519
Mailing Address - Country:US
Mailing Address - Phone:913-362-8317
Mailing Address - Fax:913-362-0169
Practice Address - Street 1:BANNER PHYSICIAN SPECIALISTS
Practice Address - Street 2:37100 N. GANTZEL RD. STE. 107
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:84140
Practice Address - Country:US
Practice Address - Phone:480-394-4480
Practice Address - Fax:602-805-2823
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS04-28701207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100370670AMedicaid
27405014OtherBLUE SHIELD KC
0446690001OtherCIGNA
200040056OtherRAILROAD MEDICARE
480765814OtherTAX ID
G98057Medicare UPIN
0446690001OtherCIGNA