MEDICARE: CHRISTOPHER LESUEUR DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2385	AZ
2	207R00000X	Internal Medicine Physician	A-1887-15	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER LESUEUR DO

Provider Business Mailing Address
First Line	:	PO BOX 6210
Second Line	:
City	:	FARMINGTON
State	:	NM
Zip	:	87499-6210
Country	:	US
Telephone Number	:	505-609-2258
Fax Number	:	505-609-2259

Provider Business Practice Location Address
First Line	:	407 S SCHWARTZ AVE
Second Line	:	STE 201
City	:	FARMINGTON
State	:	NM
Zip	:	87401-5925
Country	:	US
Telephone Number	:	505-609-6730
Fax Number	:	505-609-6749

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	09/28/2015

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Directions to “ CHRISTOPHER LESUEUR DO” Practice Location

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