Provider Demographics
NPI:1265788988
Name:LANE, DAVID M (DVM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:LANE
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 195
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:IL
Mailing Address - Zip Code:62806-0195
Mailing Address - Country:US
Mailing Address - Phone:618-446-3263
Mailing Address - Fax:618-529-2238
Practice Address - Street 1:1023 COUNTY ROAD 700 E
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:IL
Practice Address - Zip Code:62806-4438
Practice Address - Country:US
Practice Address - Phone:618-446-3263
Practice Address - Fax:618-529-2238
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0900004003174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian