Provider Demographics
NPI:1699766154
Name:LICHTENSTEIN, PAUL R (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5200 E FARNESS DR
Mailing Address - Street 2:STE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2140
Mailing Address - Country:US
Mailing Address - Phone:520-326-6882
Mailing Address - Fax:520-326-6886
Practice Address - Street 1:5200 E FARNESS DR
Practice Address - Street 2:STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2140
Practice Address - Country:US
Practice Address - Phone:520-326-6882
Practice Address - Fax:520-326-6886
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2008-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ8814207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1Z3294OtherHEALTHNET
AZAZ0056210OtherBCBS
230996OtherSTATE
AZ21108814OtherSTATE FUND
AZZ0000BGGSGMedicare PIN
C99870Medicare UPIN