Basic Information
| Provider Information | |||||||||
| NPI: | 1861879587 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LANE | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DIVISION OF ANESTHESIOLOGY WALTER REED | ||||||||
| Address2: | BLDG 9, 3RD FLOOR, 8901 WISCONSIN AVENUE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013198600 | ||||||||
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| Practice Location | |||||||||
| Address1: | DIVISION OF ANESTHESIOLOGY WALTER REED | ||||||||
| Address2: | BLDG 9, 3RD FLOOR, 8901 WISCONSIN AVENUE | ||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013198600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2015 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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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 | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207L00000X | 0101260787 | VA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.