Provider Demographics
NPI:1336366335
Name:LESUEUR, JEFFREY RAYNE (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:RAYNE
Last Name:LESUEUR
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 1:5448 HIGHWAY 260
Mailing Address - Street 2:SUITE 140
Mailing Address - City:LAKESIDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85929-5739
Mailing Address - Country:US
Mailing Address - Phone:928-532-0072
Mailing Address - Fax:928-532-0078
Practice Address - Street 1:5448 HIGHWAY 260
Practice Address - Street 2:SUITE 140
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-5739
Practice Address - Country:US
Practice Address - Phone:928-532-0072
Practice Address - Fax:928-532-0078
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ45950207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology