Provider Demographics
NPI:1821236688
Name:LANE, DAVID HOLT (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HOLT
Last Name:LANE
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 1:50 INTERLACHEN LN
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-9469
Mailing Address - Country:US
Mailing Address - Phone:952-401-6200
Mailing Address - Fax:952-401-6201
Practice Address - Street 1:50 INTERLACHEN LN
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-9469
Practice Address - Country:US
Practice Address - Phone:952-401-6200
Practice Address - Fax:952-401-6201
Is Sole Proprietor?:No
Enumeration Date:2009-01-30
Last Update Date:2011-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52897-20207L00000X
MN42949207L00000X
ND5273207L00000X
OH35-093507207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD26051Medicare UPIN