Provider Demographics
NPI:1972683019
Name:LANE, ALAN S (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:S
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 180N
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6751
Mailing Address - Country:US
Mailing Address - Phone:954-963-3336
Mailing Address - Fax:954-963-3341
Practice Address - Street 1:4000 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 180N
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6751
Practice Address - Country:US
Practice Address - Phone:954-963-3336
Practice Address - Fax:954-963-3341
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-09-04
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Provider Licenses
StateLicense IDTaxonomies
FLME19364207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL052512000Medicaid
FL93045TMedicare ID - Type Unspecified
FL052512000Medicaid