Provider Demographics
NPI:1265746655
Name:LEQUES, ALZIRA BERMUDEZ (MD)
Entity type:Individual
Prefix:
First Name:ALZIRA
Middle Name:BERMUDEZ
Last Name:LEQUES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-523-2158
Mailing Address - Fax:513-523-0019
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-523-2158
Practice Address - Fax:513-523-0019
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35095803207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3084666Medicaid
OH3084666Medicaid
OHLE4299693Medicare UPIN
OHLE4299691Medicare UPIN