Healthcare Provider Details

I. General information

NPI: 1467912527
Provider Name (Legal Business Name): ALEXANDER IWAN-SMEREKA LUDWIG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 03/12/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5196 HILL RD E STE 300
LAKEPORT CA
95453-6374
US

IV. Provider business mailing address

5196 HILL RD E STE 300
LAKEPORT CA
95453-6374
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-6885
  • Fax: 707-263-6624
Mailing address:
  • Phone: 707-263-6885
  • Fax: 707-263-6624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A20376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: