1407819584 NPI number — DR. JUDY C LANE MD

Table of content: DR. JUDY C LANE MD (NPI 1407819584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407819584 NPI number — DR. JUDY C LANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LANE
Provider First Name:
JUDY
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407819584
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9235 CROWN CREST BLVD, #200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARKER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-840-5051
Provider Business Mailing Address Fax Number:
303-840-5058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 WEST HAMPDEN AVE,
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-781-5505
Provider Business Practice Location Address Fax Number:
303-788-4220
Provider Enumeration Date:
04/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  30759 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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