1245232883 NPI number — LESTER ROBERT KLEBE DPM

Table of content: LESTER ROBERT KLEBE DPM (NPI 1245232883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245232883 NPI number — LESTER ROBERT KLEBE DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEBE
Provider First Name:
LESTER
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1245232883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10555 N TATUM BLVD
Provider Second Line Business Mailing Address:
A101
Provider Business Mailing Address City Name:
PARADISE VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85253-1096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-954-0777
Provider Business Mailing Address Fax Number:
602-954-6843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10555 N TATUM BLVD
Provider Second Line Business Practice Location Address:
A101
Provider Business Practice Location Address City Name:
PARADISE VALLEY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85253-1096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-954-0777
Provider Business Practice Location Address Fax Number:
602-954-6843
Provider Enumeration Date:
08/12/2005

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: 213E00000X , with the licence number:  0120 , 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: 701228 01 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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