Individual
LANCE L LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4700 MEMORIAL DR STE 210, BELLEVILLE, IL 62226-5373
(618) 767-7700
Mailing address
4700 MEMORIAL DR STE 210, BELLEVILLE, IL 62226-5373
(618) 767-7700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085001883
IL
363AM0700X
Medical Physician Assistant
085001883
IL
Other
Enumeration date
01/25/2006
Last updated
05/16/2023
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