Provider Demographics
NPI:1043202740
Name:LEZON, STANLEY E (CRNA)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:E
Last Name:LEZON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2127
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7127
Mailing Address - Country:US
Mailing Address - Phone:903-675-3202
Mailing Address - Fax:903-723-9891
Practice Address - Street 1:300 WILLOW CREEK PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4421
Practice Address - Country:US
Practice Address - Phone:903-723-2465
Practice Address - Fax:903-723-9891
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37573367500000X
SC3021367H00000X, 367500000X
KS55549367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1515Medicaid
TX126063007Medicaid
SC000000197423OtherUNISON
KS200421140AMedicaid
SC20056079OtherFIRST CHOICE
SC576008010015OtherTRICARE
SC576008010006OtherBLUE CHOICE
SC576008010009OtherBCBS
SCQ342557386Medicare PIN
TXTXB162895Medicare PIN
SCAN1515Medicaid
SC576008010015OtherTRICARE
KS200421140AMedicaid
KS110017024Medicare PIN