Individual
LANE O HEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3225 W GORDON AVE, SUITE 1, LAYTON, UT 84041-6508
(801) 397-6150
(901) 391-6151
Mailing address
PO BOX 5546, DENVER, CO 80217-5546
(801) 397-6150
(801) 397-6151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
378677-1206
UT
Other
Enumeration date
06/26/2006
Last updated
01/18/2017
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