Provider Demographics
NPI:1962451146
Name:BIGLER, LANE R (MD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:R
Last Name:BIGLER
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 1:6832 E BROWN ROAD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207-3755
Mailing Address - Country:US
Mailing Address - Phone:480-830-8333
Mailing Address - Fax:480-830-8390
Practice Address - Street 1:6832 E BROWN ROAD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85207-3755
Practice Address - Country:US
Practice Address - Phone:480-830-8333
Practice Address - Fax:480-830-8390
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23211207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ070010426OtherRAILROAD MEDICARE
AZ0375480OtherBCBS OF AZ
AZ4579023OtherAETNA
AZ2Z2465OtherHEALTH NET
AZZMD23211Medicare PIN
AZF60534Medicare UPIN