Provider Demographics
NPI:1669754701
Name:SQUIRES, LANE D (MD)
Entity type:Individual
Prefix:
First Name:LANE
Middle Name:D
Last Name:SQUIRES
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 1:2521 STOCKTON BLVD
Mailing Address - Street 2:#7200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-2801
Mailing Address - Fax:916-703-5011
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:#7200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-5005
Practice Address - Fax:916-703-5011
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA125847207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology