DR. JOHN SHACKELFORD LANE MD NPI 1043390172

NPI Information

NPI: 1043390172
Provider Name: DR. JOHN SHACKELFORD LANE, MD
Classification: Surgery - 2086S0129X
Entity Type: Individual

Specialization: Vascular Surgery

Organization: REGENTS OF THE UNIVESITY OF CALIFORNIA - UCSD MEDICAL GROUP

PECOS Registration: Yes

Address:
200 W ARBOR DR
MAILCODE 7403
SAN DIEGO, CA
ZIP 92103
Phone: (858) 657-7404
Get Directions

DR. John Shackelford Lane, MD is a vascular surgery surgery in San Diego, CA with 31 years of experience. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. DR. John Shackelford Lane, MD NPI is 1043390172. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
Graduation Year:1993

The provider's business location address is:

200 W ARBOR DR
MAILCODE 7403
SAN DIEGO, CA
ZIP 92103-000
Phone: (858) 657-7404
Fax: (858) 657-5033

The NPI 1043390172 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/16/2006 and was last updated on 4/4/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2086S0129X	Surgery	Vascular Surgery	000000G81602	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	H59478	MEDICARE UPIN	CALIFORNIA
2	WG81602A	MEDICARE PIN	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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