Provider Demographics
NPI:1023087467
Name:LANE, SANDRA EVELYN (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:EVELYN
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LANE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:315 E OLYMPIA AVE UNIT 211
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3823
Mailing Address - Country:US
Mailing Address - Phone:941-637-2663
Mailing Address - Fax:941-637-6872
Practice Address - Street 1:315 E OLYMPIA AVE UNIT 211
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3823
Practice Address - Country:US
Practice Address - Phone:941-637-2663
Practice Address - Fax:941-637-6872
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052191207QS0010X
FLME136355207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671269Medicaid
000000209373OtherANTHEM
311157926SALOtherSUMMIT
P00131420OtherCIGNA
310846816007OtherPRUDENTIAL
6567OtherNATIONWIDE
010064146OtherRAILROAD MEDICARE
4015568OtherAETNA
000000226360OtherANTHEM
2300473OtherUNITED HEALTHCARE
311157926SALOtherSUMMIT
2300473OtherUNITED HEALTHCARE
P00131420OtherCIGNA
310846816007OtherPRUDENTIAL