# REVIVAL MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093650806
- **Authorized official:** DR. ALAN LEE LANE MD (OWNER)
- **Authorized official phone:** (512) 757-3259

## Contact information

- **Practice address:** 1300 DACY LN BLDG 2, STE. 270, KYLE, TX 78640-4192
- **Practice address phone:** (310) 745-9935
- **Mailing address:** 119 CREST VIEW DR, LAKEWAY, TX 78734-5207
- **Mailing address phone:** (310) 745-9935

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |

## Other

- **Enumeration date:** 04/20/2026
- **Last updated:** 04/20/2026