Individual
DR. BRYAN L. LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2401 S 31ST ST, TEMPLE, TX 76508
(254) 724-2663
Mailing address
PO BOX 844658, DALLAS, TX 75284-4658
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
J6535
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0486011-01
CSHCN
TX
01
—
080161733
RR/MEDICARE
TX
05
—
1222655-01
—
TX
01
—
88791N
BLUE SHIELD
TX
Enumeration date
03/28/2006
Last updated
09/30/2020
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