Provider Demographics
NPI:1710182357
Name:LANE, W. D. PETER (LMT CNMT)
Entity Type:Individual
Prefix:MR
First Name:W. D. PETER
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:LMT CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 KIVA PL
Mailing Address - Street 2:
Mailing Address - City:SANDIA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:87047-8510
Mailing Address - Country:US
Mailing Address - Phone:505-688-6732
Mailing Address - Fax:
Practice Address - Street 1:8005 PENNSYLVANIA CIR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7810
Practice Address - Country:US
Practice Address - Phone:505-248-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1636171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor