Individual
JOHN C LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1301 S E ST, FORT SMITH, AR 72901-4716
(479) 785-2431
(479) 494-7787
Mailing address
612 S 12TH ST, FORT SMITH, AR 72901-4702
(479) 785-2431
(479) 494-7787
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E-7199
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
189401001
—
AR
05
—
200341230A
—
OK
Enumeration date
07/14/2011
Last updated
04/14/2017
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