Individual
JACOB LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1019 BROAD ST, DURHAM, NC 27705-4143
(919) 797-9588
Mailing address
5914 WOODLAWN DRIVE, DURHAM, NC 27703
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
P23269
NC
Other
Enumeration date
06/11/2024
Last updated
06/11/2024
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