Provider Demographics
NPI:1386696151
Name:LENOX, BOBBY C JR (DO)
Entity type:Individual
Prefix:
First Name:BOBBY
Middle Name:C
Last Name:LENOX
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:201 W ELROY ANSONIA RD
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:OH
Mailing Address - Zip Code:45303-9786
Mailing Address - Country:US
Mailing Address - Phone:937-337-6802
Mailing Address - Fax:937-337-7163
Practice Address - Street 1:201 W ELROY ANSONIA RD
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:OH
Practice Address - Zip Code:45303-9786
Practice Address - Country:US
Practice Address - Phone:937-337-6802
Practice Address - Fax:937-337-7163
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35005466207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0904543Medicaid
OH1386696151OtherNPI
OH1386696151OtherNPI
OH0904543Medicaid