Basic Information
| Provider Information | |||||||||
| NPI: | 1629014980 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEXOW | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2665 N DECATUR RD | ||||||||
| Address2: | SUITE 620 | ||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300336149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045017526 | ||||||||
| FaxNumber: | 4045017531 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 BROTHER GEENEN WAY | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342367102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9415563220 | ||||||||
| FaxNumber: | 9419558214 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 08/05/2019 | ||||||||
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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 | 174400000X | 021253 | GA | Y | Other Service Providers | Specialist |
No ID Information.