1215930599 NPI number — DR. STEPHEN F LEX MD

Table of content: DR. STEPHEN F LEX MD (NPI 1215930599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215930599 NPI number — DR. STEPHEN F LEX MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEX
Provider First Name:
STEPHEN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215930599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1020 N SAN FRANCISCO ST
Provider Second Line Business Mailing Address:
# 200
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-3281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-774-2300
Provider Business Mailing Address Fax Number:
928-214-2150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 N SAN FRANCISCO ST
Provider Second Line Business Practice Location Address:
# 200
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-774-2300
Provider Business Practice Location Address Fax Number:
928-214-2150
Provider Enumeration Date:
05/31/2005

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: 208200000X , with the licence number:  17751 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2004140 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 17751 . This is a "AZ STATE LICENSE #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0264810 . This is a "BLUE CROSS/BLUE SHIELD AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P282559 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 18032746 . This is a "ST COMP FUND AZ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 282559 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240004146 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8607474152004 . This is a "EMPLOYER ID #" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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