1427350149 NPI number — DR. LAWRENCE E LE ROY III D.C.

Table of content: DR. LAWRENCE E LE ROY III D.C. (NPI 1427350149)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427350149 NPI number — DR. LAWRENCE E LE ROY III D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE ROY
Provider First Name:
LAWRENCE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
III
Provider Credential Text:
D.C.
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:
1427350149
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41749 BROWNSTOWN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERMUDA DUNES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92203-1042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-636-9893
Provider Business Mailing Address Fax Number:
760-771-4880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
77564 COUNTRY CLUB DR STE 100B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM DESERT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92211-0484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-360-8700
Provider Business Practice Location Address Fax Number:
760-771-4880
Provider Enumeration Date:
12/01/2010

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: 111N00000X , with the licence number:  DC16693 , 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)





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