Jordan Bryan Lane, DO is a
Dermatology physician based in West Plains, Missouri. Jordan Bryan Lane is licensed to practice in Missouri (license number 2022025223) and his current practice location is 1100 N Kentucky Ave, West Plains, Missouri. He can be reached at his office (for appointments etc.) via phone at
(417) 256-9111.
NPI number for Jordan Bryan Lane is 1639758006 and his current mailing address is 1100 N Kentucky Ave, West Plains, Missouri. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1639758006.
Physician's Profile
| Full Name | Jordan Bryan Lane |
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| Gender | Male |
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| Speciality | Dermatology |
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| Location | 1100 N Kentucky Ave, West Plains, Missouri |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1639758006
- Provider Enumeration Date: 04/05/2021
- Last Update Date: 07/06/2025
Medical Identifiers
Medical identifiers for Jordan Bryan Lane such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1639758006 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 207N00000X | Dermatology | 2022025223 (Missouri) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jordan Bryan Lane is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Jordan Bryan Lane, DO
1100 N Kentucky Ave,
West Plains, MO 65775-2029
Ph: (417) 256-9111 | Jordan Bryan Lane, DO
1100 N Kentucky Ave,
West Plains, MO 65775-2029
Ph: (417) 256-9111 |
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