Provider Demographics
NPI:1174505176
Name:LANE, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:LANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:207 W AVENUE E
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-1820
Mailing Address - Country:US
Mailing Address - Phone:512-556-3621
Mailing Address - Fax:512-556-6594
Practice Address - Street 1:187 PR 4060
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550-4071
Practice Address - Country:US
Practice Address - Phone:512-556-3621
Practice Address - Fax:512-556-6594
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG8229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX105605OtherSUPERIOR
TX117354100OtherFIRST CARE
TX080124938OtherMEDICARE RAILROAD
TX132326302Medicaid
TX89Y900OtherBLUE CROSS/BLUE SHIELD
TX90023OtherSCOTT & WHITE
TX105605OtherSUPERIOR
TX90023OtherSCOTT & WHITE