| Doctor Name: | DR. KIM RAE LANE |
| NPI Number: | 1477548188 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 36341 |
| Business Practice Address: | 630 15th Ave Suite 200 Longmont, CO - 805012700 |
| Business Phone Number: | 3037765820 |
| Business Fax Number: | 3037763302 |
| Mailing Address: | 630 15th Ave, Suite 200 LONGMONT |
| State: | CO |
| Postal Code: | 805012700 |
| Phone Number: | 3037765820 |
| Fax Number: | 3037763302 |
| NPI Enumeration Date: | 09/19/2005 |
| NPI Last Update Date: | 07/08/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | 03/23/2006 |
| NPI Reactivation Date: | 04/07/2006 |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | 36341 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |