Provider Demographics
NPI:1386615359
Name:LESSARD, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:LESSARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 DEMERS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4018
Mailing Address - Country:US
Mailing Address - Phone:701-746-7521
Mailing Address - Fax:701-795-2553
Practice Address - Street 1:3035 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4018
Practice Address - Country:US
Practice Address - Phone:701-746-7521
Practice Address - Fax:701-795-2553
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12875Medicaid
ND023397OtherBCBS ND
MN928S6LEOtherBCBS MN
P00062982OtherRR MEDICARE
NDD26074Medicare UPIN
P00062982OtherRR MEDICARE
ND5613280001Medicare NSC
ND23397Medicare PIN