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Individual

MR. MITCHELL D LANE JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
Mailing address
9514 BONNYDUNE DR, SHREVEPORT, LA 71106-7506
(318) 617-5047

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06014
TX

Other

Enumeration date
03/19/2009
Last updated
05/24/2023
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