Provider Demographics
NPI:1942246772
Name:LANE, WILLIAM HENRY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
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 1:2006 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4192
Mailing Address - Country:US
Mailing Address - Phone:559-324-9900
Mailing Address - Fax:559-324-9902
Practice Address - Street 1:2006 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4192
Practice Address - Country:US
Practice Address - Phone:559-324-9900
Practice Address - Fax:559-324-9902
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11507Medicare UPIN
CACA175161Medicare UPIN