Individual
JACOB LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
411 LAUREL ST STE 3250, DES MOINES, IA 50314-3026
(515) 643-6400
(515) 643-5816
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-6400
(515) 643-5816
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
089244
IA
363AS0400X
Surgical Physician Assistant
860285905
AZ
Other
Enumeration date
11/28/2016
Last updated
03/04/2021
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