Provider Demographics
NPI:1285762633
Name:LOIS R. FLEMING, DPM A PODIATRY CORPORATION
Entity type:Organization
Organization Name:LOIS R. FLEMING, DPM A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:530-246-0523
Mailing Address - Street 1:441 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2406
Mailing Address - Country:US
Mailing Address - Phone:530-246-0523
Mailing Address - Fax:530-246-1321
Practice Address - Street 1:441 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2406
Practice Address - Country:US
Practice Address - Phone:530-246-0523
Practice Address - Fax:530-246-1321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3706213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000E37061Medicare PIN
DF6536Medicare PIN
ZZZ04334ZMedicare PIN