Individual
KEITH J LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
82 S 1100 E, 204, SALT LAKE CITY, UT 84102-1686
(801) 350-4602
(801) 350-4753
Mailing address
82 S 1100 E, SUITE 204, SALT LAKE CITY, UT 84102-1686
(801) 350-4602
(801) 350-4753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
180506-1205
UT
Other
Enumeration date
08/08/2006
Last updated
11/22/2011
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