Provider Demographics
NPI:1063404762
Name:LEHMAN, AUDRA (MD)
Entity type:Individual
Prefix:
First Name:AUDRA
Middle Name:
Last Name:LEHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SOUTHPOINT BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-6867
Mailing Address - Country:US
Mailing Address - Phone:707-559-7500
Mailing Address - Fax:707-559-7570
Practice Address - Street 1:1301 SOUTHPOINT BLVD
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-6867
Practice Address - Country:US
Practice Address - Phone:707-559-7500
Practice Address - Fax:707-559-7570
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI26114Medicare UPIN