Provider Demographics
NPI:1780032847
Name:JOHN G LANE, M.D. INC
Entity Type:Organization
Organization Name:JOHN G LANE, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-292-1433
Mailing Address - Street 1:3750 CONVOY STREET
Mailing Address - Street 2:STE 116
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3739
Mailing Address - Country:US
Mailing Address - Phone:858-292-1433
Mailing Address - Fax:858-292-1979
Practice Address - Street 1:3750 CONVOY STREET
Practice Address - Street 2:STE 116
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3739
Practice Address - Country:US
Practice Address - Phone:858-292-1433
Practice Address - Fax:858-292-1979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty