Provider Demographics
NPI:1194105973
Name:ALEXIS LANE, M.D., INC.
Entity type:Organization
Organization Name:ALEXIS LANE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, S-CORP
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:GRACE
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-688-8333
Mailing Address - Street 1:8055 VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3954
Mailing Address - Country:US
Mailing Address - Phone:831-688-8333
Mailing Address - Fax:831-688-8272
Practice Address - Street 1:8055 VALENCIA ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3954
Practice Address - Country:US
Practice Address - Phone:831-688-8333
Practice Address - Fax:831-688-8272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty