Individual
DOUGLAS TIMOTHY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-5345
Mailing address
3643 N ROXBORO ST, DURHAM, NC 27704-2702
(919) 470-5345
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-01070
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
560941814
TAX ID
NC
Enumeration date
10/11/2007
Last updated
04/18/2025
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