Individual
GARY E LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1925 E ORMAN AVE, SUITE A109, PUEBLO, CO 81004-3537
(719) 564-0210
(719) 564-9483
Mailing address
1925 E ORMAN AVE, SUITE A109, PUEBLO, CO 81004-3537
(719) 564-0210
(719) 564-9483
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
35242
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01352426
—
CO
Enumeration date
08/19/2005
Last updated
03/17/2014
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