Healthcare Provider Details

I. General information

NPI: 1134279532
Provider Name (Legal Business Name): LANCELOT O ALEXANDER MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E ROMIE LN 1
SALINAS CA
93901-4026
US

IV. Provider business mailing address

PO BOX 4363
SALINAS CA
93912-4363
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-7195
  • Fax: 831-422-7309
Mailing address:
  • Phone: 831-649-1000
  • Fax: 831-649-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG52251
License Number StateCA

VIII. Authorized Official

Name: LANCELOT O ALEXANDER
Title or Position: OWNER
Credential: M.D.
Phone: 831-422-7195