Provider Demographics
NPI:1013276187
Name:LANE, WESLEY GARRETT (MD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:GARRETT
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2623 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-7916
Mailing Address - Country:US
Mailing Address - Phone:806-789-8452
Mailing Address - Fax:
Practice Address - Street 1:7 SHACKLEFORD WEST BLVD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3886
Practice Address - Country:US
Practice Address - Phone:501-664-5860
Practice Address - Fax:501-664-0889
Is Sole Proprietor?:No
Enumeration Date:2012-05-10
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10043544207R00000X
ARE12014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine