Individual
TRAVIS T LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5350 TALLMAN AVE NW STE 301, SEATTLE, WA 98107-5902
(206) 320-3335
(206) 320-8027
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61132608
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1689107880
—
WA
Enumeration date
04/05/2017
Last updated
01/13/2022
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