Provider Demographics
NPI:1164589388
Name:LENOX, VALERIE R (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:R
Last Name:LENOX
Suffix:
Gender:F
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:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39502-1810
Mailing Address - Country:US
Mailing Address - Phone:228-575-1700
Mailing Address - Fax:
Practice Address - Street 1:2781 C T SWITZER SR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-4536
Practice Address - Country:US
Practice Address - Phone:228-388-0063
Practice Address - Fax:228-388-9841
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13331207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00123016Medicaid
MS110001222Medicare ID - Type UnspecifiedMEDICARE
MSE35057Medicare UPIN