1609600139 NPI number — DR. RANDY STUART WAX MD, MED, FCCM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609600139 NPI number — DR. RANDY STUART WAX MD, MED, FCCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAX
Provider First Name:
RANDY
Provider Middle Name:
STUART
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MED, FCCM
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:
1609600139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOSPITAL COURT
Provider Second Line Business Mailing Address:
OFFICE OF THE CHIEF OF STAFF, LAKERIDGE HEALTH
Provider Business Mailing Address City Name:
OSHAWA
Provider Business Mailing Address State Name:
ZZ - FOREIGN COUNTRIES
Provider Business Mailing Address Postal Code:
L1G 2B9
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOSPITAL COURT
Provider Second Line Business Practice Location Address:
OFFICE OF THE CHIEF OF STAFF, LAKERIDGE HEALTH
Provider Business Practice Location Address City Name:
OSHAWA
Provider Business Practice Location Address State Name:
ZZ - FOREIGN COUNTRIES
Provider Business Practice Location Address Postal Code:
L1G 2B9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
905-576-8711
Provider Business Practice Location Address Fax Number:
416-907-3411
Provider Enumeration Date:
08/28/2024

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: 207RC0200X , with the licence number:  4301111223 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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