Provider Demographics
NPI:1124089248
Name:LANES, DOUGLAS MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:LANES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3700 WASHINGTON ST
Mailing Address - Street 2:STE 304
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-8256
Mailing Address - Country:US
Mailing Address - Phone:954-961-1500
Mailing Address - Fax:954-961-7942
Practice Address - Street 1:3700 WASHINGTON ST
Practice Address - Street 2:STE 304
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8256
Practice Address - Country:US
Practice Address - Phone:954-961-1500
Practice Address - Fax:954-961-7942
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME773962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257355500Medicaid
FL257355500Medicaid
D03370Medicare UPIN