Healthcare Provider Details

I. General information

NPI: 1265859961
Provider Name (Legal Business Name): CHRISTOPHER DALE LEZU PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRIS D LEZU PA-C

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10626 CHAPMAN HWY
SEYMOUR TN
37865-4703
US

IV. Provider business mailing address

1275 DICK LONAS RD
KNOXVILLE TN
37909-1382
US

V. Phone/Fax

Practice location:
  • Phone: 865-577-5231
  • Fax: 833-908-2179
Mailing address:
  • Phone: 865-584-4747
  • Fax: 865-584-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2719
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2719
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2719
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: