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NPI Code Detail

MEDICARE: RONALD J LEMELIN PA-C

MEDICARE: RONALD J LEMELIN 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
1363AM0700XMedical Physician Assistant2001PA01NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023013216
Entity Type Code : Individual
Provider Name (Legal Business Name) : RONALD J LEMELIN PA-C
Provider Business Mailing Address
First Line : 3411 N 5TH AVE
Second Line : STE 209
City : PHOENIX
State : AZ
Zip : 85013-3812
Country : US
Telephone Number : 602-789-0344
Fax Number : 602-870-7566
Provider Business Practice Location Address
First Line : 8208 LOUISIANA BLVD NE
Second Line : SUITE C
City : ALBUQUERQUE
State : NM
Zip : 87113-1757
Country : US
Telephone Number : 505-858-1222
Fax Number : 505-858-1224
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 11/02/2017

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Directions to “ RONALD J LEMELIN PA-C” Practice Location

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