Provider Demographics
NPI:1225123789
Name:FLEMING, LOIS R (DPM)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:R
Last Name:FLEMING
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-2406
Mailing Address - Country:US
Mailing Address - Phone:530-246-0523
Mailing Address - Fax:530-246-1321
Practice Address - Street 1:441 LAKE BLVD
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-2406
Practice Address - Country:US
Practice Address - Phone:530-246-0523
Practice Address - Fax:530-246-1321
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3706213E00000X
CARHD 133809213ER0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E37060Medicaid
CADF6536Medicare PIN
CA000E37060Medicaid
CA000E37061Medicare PIN
CAU27346Medicare UPIN