1003053323 NPI number — DR. JAMIE LYNDON STECKLEY M.D.

Table of content: DR. JAMIE LYNDON STECKLEY M.D. (NPI 1003053323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003053323 NPI number — DR. JAMIE LYNDON STECKLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STECKLEY
Provider First Name:
JAMIE
Provider Middle Name:
LYNDON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003053323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
872 RED OAK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONDON
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
N6H 5R6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
519-474-3613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
872 RED OAK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
ONTARIO
Provider Business Practice Location Address Postal Code:
N6H 5R6
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
519-474-3613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  80974 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)