Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 041870 | GA |
NPI | 1043248578 |
---|---|
Provider Name | Paul David Lesko |
First Address | Albuquerque, NM 87108-5153 |
Second Address | Albuquerque, NM 87108-5153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 03/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000089850 | (05) | GA |
000089851 | (05) | GA |
B69312 | (02) | GA |