Individual
SANDRA EVELYN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
315 E OLYMPIA AVE UNIT 211, PUNTA GORDA, FL 33950-3823
(941) 637-2663
(941) 637-6872
Mailing address
315 E OLYMPIA AVE UNIT 211, PUNTA GORDA, FL 33950-3823
(941) 637-2663
(941) 637-6872
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
35052191
OH
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
ME136355
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209373
ANTHEM
—
01
—
000000226360
ANTHEM
—
01
—
010064146
RAILROAD MEDICARE
—
05
—
0671269
—
OH
01
—
2300473
UNITED HEALTHCARE
—
01
—
310846816007
PRUDENTIAL
—
01
—
311157926SAL
SUMMIT
—
01
—
4015568
AETNA
—
01
—
6567
NATIONWIDE
—
01
—
P00131420
CIGNA
—
Enumeration date
03/17/2006
Last updated
01/14/2020
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