Provider Demographics
NPI:1508487042
Name:LANE, JONMARK BAKER (MD)
Entity Type:Individual
Prefix:
First Name:JONMARK
Middle Name:BAKER
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:501-202-2300
Mailing Address - Fax:501-202-1449
Practice Address - Street 1:9601 BAPTIST HEALTH DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6321
Practice Address - Country:US
Practice Address - Phone:501-202-2300
Practice Address - Fax:501-202-1449
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-16801207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine