Provider Demographics
NPI:1194879981
Name:LANE, ALFRED THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:THOMAS
Last Name:LANE
Suffix:
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 1:1018 LOMA PRIETA CT
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5024
Mailing Address - Country:US
Mailing Address - Phone:650-960-1354
Mailing Address - Fax:
Practice Address - Street 1:900 BLAKE WILBUR DR.
Practice Address - Street 2:W0071
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-5334
Practice Address - Country:US
Practice Address - Phone:650-723-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26128207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB72493Medicare UPIN