Provider Demographics
NPI:1730930637
Name:JESSICA LANE MD PLLC
Entity type:Organization
Organization Name:JESSICA LANE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-797-3888
Mailing Address - Street 1:1925 W ORANGE GROVE RD STE 302
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1152
Mailing Address - Country:US
Mailing Address - Phone:520-797-3888
Mailing Address - Fax:
Practice Address - Street 1:1925 W ORANGE GROVE RD STE 302
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1152
Practice Address - Country:US
Practice Address - Phone:520-797-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty