Provider Demographics
NPI:1033163373
Name:ALEXANDER, LONNIE DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:DAVID
Last Name:ALEXANDER
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 1:2000 W. 21ST STREET
Mailing Address - Street 2:STE A-1
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-762-8055
Mailing Address - Fax:575-763-3351
Practice Address - Street 1:2000 W. 21ST STREET
Practice Address - Street 2:STE A-1
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-762-8055
Practice Address - Fax:575-763-3351
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM86-003207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00036624Medicaid
NM00036624Medicaid