Provider Demographics
NPI:1124079306
Name:LAIN, EDWARD LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEWIS
Last Name:LAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:5145 FM 620 N STE B-110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-1815
Mailing Address - Country:US
Mailing Address - Phone:512-266-0007
Mailing Address - Fax:512-266-0077
Practice Address - Street 1:5145 FM 620 N STE B-110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-1815
Practice Address - Country:US
Practice Address - Phone:512-266-0007
Practice Address - Fax:512-266-0077
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2684207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology