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Individual

DR. KIM RAE LANE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
630 15TH AVE, SUITE 200, LONGMONT, CO 80501-2700
(303) 776-5820
(303) 776-3302
Mailing address
630 15TH AVE, SUITE 200, LONGMONT, CO 80501-2700
(303) 776-5820
(303) 776-3302

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36341
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
77633024
CO
Enumeration date
09/19/2005
Last updated
07/08/2010
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