Provider Demographics
NPI:1134419740
Name:LG&H INTERNAL MEDICINE CLINIC
Entity type:Organization
Organization Name:LG&H INTERNAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:FLORES
Authorized Official - Last Name:LEON GUERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-475-5544
Mailing Address - Street 1:PO BOX 3268
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-3268
Mailing Address - Country:US
Mailing Address - Phone:671-475-5544
Mailing Address - Fax:671-475-5545
Practice Address - Street 1:J&G COMMERCIAL PLAZA BLDG C
Practice Address - Street 2:SUITE 107
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-475-5544
Practice Address - Fax:671-475-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1647207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty