Provider Demographics
NPI:1649584251
Name:LANES, SHOLOMO JOSEP (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOLOMO
Middle Name:JOSEP
Last Name:LANES
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 1:3850 HOLLYWOOD BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6745
Mailing Address - Country:US
Mailing Address - Phone:954-961-1200
Mailing Address - Fax:954-963-0378
Practice Address - Street 1:3850 HOLLYWOOD BLVD STE 301
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021
Practice Address - Country:US
Practice Address - Phone:954-961-1200
Practice Address - Fax:954-963-0378
Is Sole Proprietor?:No
Enumeration Date:2010-08-06
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105742174400000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME105742OtherFLORIDA MEDICAL LICENSE