Provider Demographics
NPI:1124092671
Name:LANO, CHARLES F JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:LANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GRUENE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-4136
Mailing Address - Country:US
Mailing Address - Phone:830-629-5830
Mailing Address - Fax:830-629-3647
Practice Address - Street 1:42 GRUENE PARK DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2460
Practice Address - Country:US
Practice Address - Phone:830-629-5830
Practice Address - Fax:830-629-3647
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9902207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBLUE CROSSOther82890X
TX043649501Medicaid
TXBLUE CROSSOther82890X
TX043649501Medicaid