Active NPI
Lamar Richard Innes, ATC
- Athletic Trainer
- Douglas, AZ
National Provider Identifier
1457752115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1203
- Practice address
- 4190 W Highway 80
Douglas, AZ 85607-6100 - Phone
- (520) 417-4124
- Fax
- (520) 417-4096
- NPI assigned
- Sep 11, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1203 | AZ | Primary |
Addresses
Primary practice location
4190 W Highway 80
Douglas, AZ 85607-6100
Mailing address
4190 W Highway 80
Douglas, AZ 85607-6100
Phone (520) 417-4124
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1203 | AZ | MD | Gerontology Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410393600000",
"number": "1457752115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4190 W HIGHWAY 80",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856076100",
"telephone_number": "520-417-4124",
"fax_number": "520-417-4096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4190 W HIGHWAY 80",
"city": "DOUGLAS",
"state": "AZ",
"postal_code": "856076100",
"telephone_number": "520-417-4124",
"fax_number": "520-417-4096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INNES",
"first_name": "LAMAR",
"middle_name": "RICHARD",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-09-11",
"last_updated": "2014-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AZ",
"license": "1203",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Douglas, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.