MEDICARE: MR. JAMES ARTHUR LESSARD PA-C

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	1710I1002X	Independent Duty Corpsman
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1447213665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ARTHUR LESSARD PA-C

Provider Business Mailing Address
First Line	:	778 WINDBROOK CIR
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23602-8862
Country	:	US
Telephone Number	:	757-272-0660
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS ABRAHAM LINCOLN # 72
Second Line	:
City	:	FPO
State	:	AP
Zip	:	96612-2872
Country	:	US
Telephone Number	:	757-817-3943
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	11/14/2011

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