Individual
DR. PAUL DOLPHOUS LANE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3527 N VALDOSTA RD, VALDOSTA, GA 31602-6418
(229) 247-2290
(229) 247-0091
Mailing address
3527 N VALDOSTA RD, VALDOSTA, GA 31602-6418
(229) 247-2290
(229) 247-0091
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
003121
GA
207X00000X
Orthopaedic Surgery Physician
ME115924
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008920900
—
FL
01
—
5608789
AETNA
FL
01
—
I4Q3R
BCBS
FL
Enumeration date
06/25/2008
Last updated
06/26/2014
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