Provider Demographics
NPI:1689905119
Name:FRANK B LANE MD PA
Entity type:Organization
Organization Name:FRANK B LANE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:B
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-872-0702
Mailing Address - Street 1:PO BOX 18327
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-8327
Mailing Address - Country:US
Mailing Address - Phone:813-872-0702
Mailing Address - Fax:813-876-0997
Practice Address - Street 1:2605 W SWANN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4039
Practice Address - Country:US
Practice Address - Phone:813-872-0702
Practice Address - Fax:813-876-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME12971207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDP9685OtherRAILROAD MEDICARE
FLCT637AMedicare PIN