Healthcare Provider Details

I. General information

NPI: 1487673042
Provider Name (Legal Business Name): JOHN ALLEN LIONBARGER AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5109 COORS BLVD NW STE D
ALBUQUERQUE NM
87120-1925
US

IV. Provider business mailing address

70 STEEPLE CHASE DR
TIJERAS NM
87059
US

V. Phone/Fax

Practice location:
  • Phone: 505-890-7373
  • Fax: 505-890-8621
Mailing address:
  • Phone: 505-281-6512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number525
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: