Provider Demographics
NPI:1518016096
Name:LESSER, MARVIN DEAN (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:DEAN
Last Name:LESSER
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 1:2110 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8878
Mailing Address - Country:US
Mailing Address - Phone:928-344-1891
Mailing Address - Fax:928-726-6306
Practice Address - Street 1:2110 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8878
Practice Address - Country:US
Practice Address - Phone:928-344-1891
Practice Address - Fax:928-726-6306
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36398207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ630130Medicaid