Individual
JACOB S LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-7538
(843) 792-3298
Mailing address
169 ASHLEY AVE RM 202, CHARLESTON, SC 29425-7538
(843) 792-3298
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
89713
SC
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/28/2020
Last updated
05/31/2023
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