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Individual
MR. MICHAEL J LANE
Active
Individual
MR. MICHAEL J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
M7247
ID
363A00000X
Physician Assistant
Primary
PA377
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010140814
BLUE SHIELD OF ID; BOISE
ID
01
—
000010145063
BLUE SHIELD OF ID; EMMETT
ID
05
—
806272300
—
ID
05
—
806272301
—
ID
01
—
DI593
BLUE CROSS OF ID
ID
Enumeration date
06/13/2006
Last updated
12/05/2014
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