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Individual

BRANDON KEITH LANE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
6828 SE HOLGATE BLVD, PORTLAND, OR 97206-3504
(503) 332-4969
Mailing address
3804 N JUNEAU ST, PORTLAND, OR 97217-7427

Taxonomy

Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary

Other

Enumeration date
12/12/2023
Last updated
12/12/2023
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