Individual
DR. CHARLES S LANE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
300 WERNER ST, HOT SPRINGS, AR 71913-6406
(501) 802-0013
(501) 623-1465
Mailing address
PO BOX 6005, HOT SPRINGS, AR 71902-6005
(501) 802-0013
(501) 623-1465
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
C5421
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102459001
—
AR
01
—
260001316
RAILROAD MEDICARE
AR
01
—
53036
BLUE CROSS BLUE SHIELD AR
AR
01
—
B002
WPS TRICARE
AR
Enumeration date
05/23/2005
Last updated
05/04/2012
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