1. Home
  2. Directory
  3. Alabama
  4. Montgomery
  5. Radiology
  6. NPI Profile
  7. NPI Record 1336133735

DR. MARK H LEQUIRE M.D.
Complete NPI Record 1336133735
Radiology - Diagnostic Radiology in Montgomery, AL


Quality Rating: 79.57 out of 100 score

NPI Status: Active since August 31, 2005

Contact Information

2055 NORMANDIE DR
SUITE 108
MONTGOMERY, AL
ZIP 36111
Phone: (334) 288-4624
Fax: (334) 280-3628

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Second Line Business Mailing Address
  10. Provider Business Mailing Address City Name
  11. Provider Business Mailing Address State Name
  12. Provider Business Mailing Address Postal Code
  13. Provider Business Mailing Address Country Code If outside U S
  14. Provider Business Mailing Address Telephone Number
  15. Provider Business Mailing Address Fax Number
  16. Provider First Line Business Practice Location Address
  17. Provider Second Line Business Practice Location Address
  18. Provider Business Practice Location Address City Name
  19. Provider Business Practice Location Address State Name
  20. Provider Business Practice Location Address Postal Code
  21. Provider Business Practice Location Address Country Code If outside U S
  22. Provider Business Practice Location Address Telephone Number
  23. Provider Business Practice Location Address Fax Number
  24. Provider Enumeration Date
  25. Last Update Date
  26. Provider Gender Code
  27. Healthcare Provider Taxonomy Code 1
  28. Provider License Number 1
  29. Provider License Number State Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Healthcare Provider Taxonomy Code 2
  32. Provider License Number 2
  33. Provider License Number State Code 2
  34. Healthcare Provider Primary Taxonomy Switch 2
  35. Healthcare Provider Taxonomy Code 3
  36. Provider License Number 3
  37. Provider License Number State Code 3
  38. Healthcare Provider Primary Taxonomy Switch 3
  39. Healthcare Provider Taxonomy Code 4
  40. Provider License Number 4
  41. Provider License Number State Code 4
  42. Healthcare Provider Primary Taxonomy Switch 4
  43. Healthcare Provider Taxonomy Code 5
  44. Provider License Number 5
  45. Provider License Number State Code 5
  46. Healthcare Provider Primary Taxonomy Switch 5
  47. Healthcare Provider Taxonomy Code 6
  48. Provider License Number 6
  49. Provider License Number State Code 6
  50. Healthcare Provider Primary Taxonomy Switch 6
  51. Healthcare Provider Taxonomy Code 7
  52. Provider License Number 7
  53. Provider License Number State Code 7
  54. Healthcare Provider Primary Taxonomy Switch 7
  55. Healthcare Provider Taxonomy Code 8
  56. Provider License Number 8
  57. Provider License Number State Code 8
  58. Healthcare Provider Primary Taxonomy Switch 8
  59. Healthcare Provider Taxonomy Code 9
  60. Provider License Number 9
  61. Provider License Number State Code 9
  62. Healthcare Provider Primary Taxonomy Switch 9
  63. Healthcare Provider Taxonomy Code 10
  64. Provider License Number 10
  65. Provider License Number State Code 10
  66. Healthcare Provider Primary Taxonomy Switch 10
  67. Healthcare Provider Taxonomy Code 11
  68. Provider License Number 11
  69. Provider License Number State Code 11
  70. Healthcare Provider Primary Taxonomy Switch 11
  71. Healthcare Provider Taxonomy Code 12
  72. Provider License Number 12
  73. Provider License Number State Code 12
  74. Healthcare Provider Primary Taxonomy Switch 12
  75. Healthcare Provider Taxonomy Code 13
  76. Provider License Number 13
  77. Provider License Number State Code 13
  78. Healthcare Provider Primary Taxonomy Switch 13
  79. Healthcare Provider Taxonomy Code 14
  80. Provider License Number 14
  81. Provider License Number State Code 14
  82. Healthcare Provider Primary Taxonomy Switch 14
  83. Other Provider Identifier 1
  84. Other Provider Identifier Type Code 1
  85. Other Provider Identifier State 1
  86. Other Provider Identifier 2
  87. Other Provider Identifier Type Code 2
  88. Other Provider Identifier State 2
  89. Other Provider Identifier 3
  90. Other Provider Identifier Type Code 3
  91. Other Provider Identifier State 3
  92. Other Provider Identifier 4
  93. Other Provider Identifier Type Code 4
  94. Other Provider Identifier State 4
  95. Other Provider Identifier 5
  96. Other Provider Identifier Type Code 5
  97. Other Provider Identifier State 5
  98. Other Provider Identifier Issuer 5
  99. Other Provider Identifier 6
  100. Other Provider Identifier Type Code 6
  101. Other Provider Identifier State 6
  102. Other Provider Identifier Issuer 6
  103. Other Provider Identifier 7
  104. Other Provider Identifier Type Code 7
  105. Other Provider Identifier State 7
  106. Other Provider Identifier 8
  107. Other Provider Identifier Type Code 8
  108. Other Provider Identifier State 8
  109. Other Provider Identifier 9
  110. Other Provider Identifier Type Code 9
  111. Other Provider Identifier State 9
  112. Other Provider Identifier 10
  113. Other Provider Identifier Type Code 10
  114. Other Provider Identifier State 10
  115. Other Provider Identifier 11
  116. Other Provider Identifier Type Code 11
  117. Other Provider Identifier State 11
  118. Other Provider Identifier Issuer 11
  119. Other Provider Identifier 12
  120. Other Provider Identifier Type Code 12
  121. Other Provider Identifier State 12
  122. Other Provider Identifier 13
  123. Other Provider Identifier Type Code 13
  124. Other Provider Identifier State 13
  125. Other Provider Identifier 14
  126. Other Provider Identifier Type Code 14
  127. Other Provider Identifier State 14
  128. Other Provider Identifier 15
  129. Other Provider Identifier Type Code 15
  130. Other Provider Identifier State 15
  131. Other Provider Identifier 16
  132. Other Provider Identifier Type Code 16
  133. Other Provider Identifier State 16
  134. Other Provider Identifier 17
  135. Other Provider Identifier Type Code 17
  136. Other Provider Identifier State 17
  137. Other Provider Identifier 18
  138. Other Provider Identifier Type Code 18
  139. Other Provider Identifier State 18
  140. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1336133735. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1336133735
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code: 1
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: MARK
The first name of the provider, if the provider is an individual.
Provider Middle Name: H
The middle name of the provider, if the provider is an individual.
Provider Name Prefix Text: DR.
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Credential Text: M.D.
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider First Line Business Mailing Address: 2055 NORMANDIE DR
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing Address: SUITE 108
The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City Name: MONTGOMERY
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: AL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 361112732
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 3342884624
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 3342803628
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2055 NORMANDIE DR
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address: SUITE 108
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: MONTGOMERY
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: AL
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 361112732
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 3342884624
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 3342803628
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/31/2005
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 11/2/2011
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 2085R0202X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: 00013481
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1: AL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
Healthcare Provider Taxonomy Code 2: 2085R0202X
Provider License Number 2: 34736
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2: TN
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 2085R0202X
Provider License Number 3: H3097
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: TX
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Healthcare Provider Taxonomy Code 4: 2085R0202X
Provider License Number 4: 0000-39011
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4: NC
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4: N
Healthcare Provider Taxonomy Code 5: 2085R0202X
Provider License Number 5: 35-07-9272-L
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 5: OH
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 5: N
Healthcare Provider Taxonomy Code 6: 2085R0202X
Provider License Number 6: 20761
Provider License Number State Code 6: SC
Healthcare Provider Primary Taxonomy Switch 6: N
Healthcare Provider Taxonomy Code 7: 2085R0202X
Provider License Number 7: ME89827
Provider License Number State Code 7: FL
Healthcare Provider Primary Taxonomy Switch 7: N
Healthcare Provider Taxonomy Code 8: 2085R0204X
Provider License Number 8: 34736
Provider License Number State Code 8: TN
Healthcare Provider Primary Taxonomy Switch 8: N
Healthcare Provider Taxonomy Code 9: 2085R0204X
Provider License Number 9: H3097
Provider License Number State Code 9: TX
Healthcare Provider Primary Taxonomy Switch 9: N
Healthcare Provider Taxonomy Code 10: 2085R0204X
Provider License Number 10: 0000-39011
Provider License Number State Code 10: NC
Healthcare Provider Primary Taxonomy Switch 10: N
Healthcare Provider Taxonomy Code 11: 2085R0204X
Provider License Number 11: 35-07-9272-L
Provider License Number State Code 11: OH
Healthcare Provider Primary Taxonomy Switch 11: N
Healthcare Provider Taxonomy Code 12: 2085R0204X
Provider License Number 12: 20761
Provider License Number State Code 12: SC
Healthcare Provider Primary Taxonomy Switch 12: N
Healthcare Provider Taxonomy Code 13: 2085R0204X
Provider License Number 13: ME89827
Provider License Number State Code 13: FL
Healthcare Provider Primary Taxonomy Switch 13: N
Healthcare Provider Taxonomy Code 14: 2085R0204X
Provider License Number 14: 00013481
Provider License Number State Code 14: AL
Healthcare Provider Primary Taxonomy Switch 14: N
Other Provider Identifier 1: 009971820
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 1: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1: AL
Other Provider Identifier 2: 108071
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 2: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2: AL
Other Provider Identifier 3: 270021200
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 3: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3: FL
Other Provider Identifier 4: 009930805
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 4: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 4: AL
Other Provider Identifier 5: 051504364
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 5: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 5: AL
Other Provider Identifier Issuer 5: IDTF
Other Provider Identifier 6: 000058867
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 6: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 6: AL
Other Provider Identifier Issuer 6: IDTF
Other Provider Identifier 7: 108246
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 7: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 7: AL
Other Provider Identifier 8: 009951085
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 8: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 8: AL
Other Provider Identifier 9: 009971800
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 9: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 9: AL
Other Provider Identifier 10: 051551047
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 10: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 10: AL
Other Provider Identifier 11: 000058866
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 11: 01
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 11: AL
Other Provider Identifier Issuer 11: IDTF
Other Provider Identifier 12: 009922335
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 12: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 12: AL
Other Provider Identifier 13: 009928435
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 13: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 13: AL
Other Provider Identifier 14: 107037
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 14: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 14: AL
Other Provider Identifier 15: 009971830
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 15: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 15: AL
Other Provider Identifier 16: 009972715
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 16: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 16: AL
Other Provider Identifier 17: 009973725
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 17: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 17: AL
Other Provider Identifier 18: 107038
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 18: 05
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 18: AL
Is Sole Proprietor: Y
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No