1336133735 NPI number — DR. MARK H LEQUIRE M.D.

Table of content: DR. MARK H LEQUIRE M.D. (NPI 1336133735)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336133735 NPI number — DR. MARK H LEQUIRE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEQUIRE
Provider First Name:
MARK
Provider Middle Name:
H
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:
1336133735
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 NORMANDIE DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36111-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-288-4624
Provider Business Mailing Address Fax Number:
334-280-3628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 NORMANDIE DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-4624
Provider Business Practice Location Address Fax Number:
334-280-3628
Provider Enumeration Date:
08/31/2005

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: 2085R0202X , with the licence number:  00013481 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X , with the licence number: ME89827 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 20761 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 35-07-9272-L , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 0000-39011 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: H3097 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 34736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 00013481 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: ME89827 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 20761 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 35-07-9272-L , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 0000-39011 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: H3097 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 34736 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 009971820 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009973725 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058867 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 009930805 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009971800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000058866 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 107037 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108071 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051551047 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009922335 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009971830 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107038 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108246 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 270021200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009928435 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009972715 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009951085 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 051504364 . This is a "IDTF" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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