Individual
CASSIDY MARIE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 S MAIN ST, FORT WORTH, TX 76104-4917
(817) 702-3431
Mailing address
10301 BRIDGETOWN LN, CROWLEY, TX 76036-3998
(903) 312-1686
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
V3362
TX
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
TX
Other
Enumeration date
04/03/2023
Last updated
02/16/2025
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