Individual
BARRETT DUSTIN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7257 HAWKINS VIEW DR, FORT WORTH, TX 76132-3921
(817) 735-9397
(817) 735-8340
Mailing address
7257 HAWKINS VIEW DR, FORT WORTH, TX 76132-3921
(817) 735-9397
(817) 735-8340
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06292
TX
363AM0700X
Medical Physician Assistant
PA06292
TX
363AS0400X
Surgical Physician Assistant
PA06292
TX
Other
Enumeration date
07/24/2009
Last updated
12/06/2011
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