Individual
LANE A WILNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2501 S VANCE DR, FLORENCE, SC 29505-6163
(843) 665-1280
(843) 679-4246
Mailing address
2501 S VANCE DR, FLORENCE, SC 29505-6163
(843) 665-1280
(843) 679-4246
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
19078
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
571108959
FEDERAL TAX ID
SC
05
—
GP3084
—
SC
Enumeration date
05/08/2006
Last updated
12/16/2009
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