Provider Demographics
NPI:1386806727
Name:LANE, SARA K (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:K
Last Name:LANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9260 ESTERO PARK COMMONS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6468
Mailing Address - Country:US
Mailing Address - Phone:239-908-3593
Mailing Address - Fax:239-908-3597
Practice Address - Street 1:9260 ESTERO PARK COMMONS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6468
Practice Address - Country:US
Practice Address - Phone:239-908-3593
Practice Address - Fax:239-908-3597
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 111008208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14FZ2OtherFL BLUE
FL004015700Medicaid