Provider Demographics
NPI:1629099478
Name:LANE, LORI A (DPM)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:LANE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 S CONGRESS AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-7617
Mailing Address - Country:US
Mailing Address - Phone:561-433-5577
Mailing Address - Fax:
Practice Address - Street 1:2326 S CONGRESS AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7617
Practice Address - Country:US
Practice Address - Phone:561-433-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0002500213ES0131X
FLPO2500213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390297800Medicaid
FL65409Medicare ID - Type UnspecifiedMEDICARE NUMBER
FL390297800Medicaid