Individual
PAUL RYAN LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4101 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-6222
(618) 246-1247
Mailing address
4101 N WATER TOWER PL, MOUNT VERNON, IL 62864-6296
(618) 244-6222
(618) 246-1247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.007905
IL
Other
Enumeration date
05/01/2020
Last updated
12/18/2020
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