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1750522868
MITCHELL D LANE
SHREVEPORT, LA
NPI
1750522868
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: TX PA06014)
Enumeration Date
2009-03-19
Last Update Date
2023-05-24
Business Address
Mr. MITCHELL D LANE PA-C
510 E STONER AVE
SHREVEPORT, LA 71101-4243
Phone number: 318-221-8411
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Mailing Address
Mr. MITCHELL D LANE PA-C
9514 BONNYDUNE DR
SHREVEPORT, LA 71106-7506
Phone number: 318-617-5047
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