Paul Ryan Lane, PA-C
NPI #1962023820 in Mount Vernon, Illinois
Provider Information
- NPI Number
- 1962023820
- Entity Type
- Individual
- Name
- Paul Ryan Lane, PA-C
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Physician Assistant
- Credential
- PA-C
- Enumeration Date
- May 1, 2020
- Last Updated
- Dec 18, 2020
Practice Location
- Address
- 4101 N WATER TOWER PL
- City
- Mount Vernon
- State
- Illinois
- ZIP Code
- 62864-6296
- Phone
- (618) 244-6222
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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