Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | L8412 | TX |
NPI | 1003842907 |
---|---|
Provider Name | Gregg A Lessly |
First Address | Allen, TX 75013-6510 |
Second Address | Allen, TX 75013-6103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
169347501 | (05) | TX |
169347502 | (05) | TX |
169347503 | (05) | TX |
8BE093 | BCBS (01) | TX |
8P0970 | BLUE SHIELD (01) | TX |
P00719299 | RAILROAD (01) | TX |