Basic Information
| Provider Information | |||||||||
| NPI: | 1528166410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LENZO | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | GREGORY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 S 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283484711 | ||||||||
| FaxNumber: | 6202521715 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 S 20TH AVE | ||||||||
| Address2: | |||||||||
| City: | SAFFORD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 855464011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283484711 | ||||||||
| FaxNumber: | 9283485701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 04-31538 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | BL9488950 | 01 | DEA | OTHER | 200357280A | 05 | KS | MEDICAID |