Individual
DR. LANE LAMAR WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
BLDG 813 ROOM 104, FORT CARSON, CO 80913
(719) 524-7350
Mailing address
BLDG 813 ROOM 104, FORT CARSON, CO 80913
(719) 524-7350
Taxonomy
Speciality
Code
Description
License number
State
2083A0100X
Aerospace Medicine Physician
182257-1205
UT
2083X0100X
Occupational Medicine Physician
Primary
182257-1205
UT
Other
Enumeration date
08/18/2005
Last updated
04/20/2015
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