1487609236 NPI number — DR. DAVID M LEFLER JR. DO

Table of content: DR. DAVID M LEFLER JR. DO (NPI 1487609236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487609236 NPI number — DR. DAVID M LEFLER JR. DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEFLER
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DO
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:
1487609236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 HUFFMAN ROAD
Provider Second Line Business Mailing Address:
24-691
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-770-0412
Provider Business Mailing Address Fax Number:
807-770-0435

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 HUFFMAN ROAD
Provider Second Line Business Practice Location Address:
24-691
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-770-0412
Provider Business Practice Location Address Fax Number:
807-770-0435
Provider Enumeration Date:
05/23/2006

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: 207RN0300X , with the licence number:  7137 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: DOS-1270 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 0102201420 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5108807 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89066J2 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010131545 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171779 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 5923388 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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