1457529612 NPI number — TONY L LLOYD M.D., INC.

Table of content: (NPI 1457529612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457529612 NPI number — TONY L LLOYD M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TONY L LLOYD M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1457529612
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 188
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95361-0188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-845-1350
Provider Business Mailing Address Fax Number:
209-845-1364

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 GUZZI LN
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
SONORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95370-5288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-588-8840
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LLOYD
Authorized Official First Name:
TONY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
209-588-8840

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A88900 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0414937 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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