Basic Information
| Provider Information | |||||||||
| NPI: | 1558343681 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | RANDALL | ||||||||
| MiddleName: | CURTIS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CERTIFIED PHYSICIAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 S. WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039381146 | ||||||||
| FaxNumber: | 9039272434 | ||||||||
| Practice Location | |||||||||
| Address1: | 811 S. WASHINGTON STREET | ||||||||
| Address2: | |||||||||
| City: | MARSHALL | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9039381146 | ||||||||
| FaxNumber: | 9039272434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2005 | ||||||||
| LastUpdateDate: | 05/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA04303 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.