Provider Demographics
NPI:1932100831
Name:XAVIER, LYNDON C (MD)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:C
Last Name:XAVIER
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:PO BOX 7810
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7810
Mailing Address - Country:US
Mailing Address - Phone:480-275-7944
Mailing Address - Fax:480-745-1800
Practice Address - Street 1:725 S DOBSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5680
Practice Address - Country:US
Practice Address - Phone:480-814-0266
Practice Address - Fax:480-814-0018
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28442207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ779192Medicaid
AZP00042695OtherRAILROAD MEDICARE
AZWCSKQOtherSUN HEALTH GROUP #
AZH83892Medicare UPIN
AZ779192Medicaid
AZZ74637Medicare PIN
AZP00042695Medicare PIN