Provider Demographics
NPI:1013946532
Name:LEMIEUX, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:LEMIEUX
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 1:6630 S. MCCARRAN BLVD
Mailing Address - Street 2:BLDNG B SUITE 16
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6145
Mailing Address - Country:US
Mailing Address - Phone:775-323-5116
Mailing Address - Fax:775-323-7140
Practice Address - Street 1:6630 S. MCCARRAN BLVD
Practice Address - Street 2:BLDNG B SUITE 16
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6145
Practice Address - Country:US
Practice Address - Phone:775-323-5116
Practice Address - Fax:775-323-7140
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3602207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
010000822OtherRR MEDICARE
NV002016151Medicaid
C96263Medicare UPIN
V942148201Medicare ID - Type Unspecified
AV129YMedicare PIN