Provider Demographics
NPI:1851453278
Name:LANE, HERBERT TOMMY (DPM)
Entity Type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:TOMMY
Last Name:LANE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 SOUTH MCCALL RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34224
Mailing Address - Country:US
Mailing Address - Phone:941-473-3338
Mailing Address - Fax:941-474-8597
Practice Address - Street 1:2400 SOUTH MCCALL RD
Practice Address - Street 2:SUITE F
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34224
Practice Address - Country:US
Practice Address - Phone:941-473-3338
Practice Address - Fax:941-474-8597
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 0002446213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP02446OtherFLA LIC NUMBER
FLP02446OtherFLA LIC NUMBER
5632150001Medicare NSC
T72743Medicare UPIN