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Individual

LOUELLA M REGIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301083835
MI
207Q00000X
Family Medicine Physician
Primary
A101548
CA
207Q00000X
Family Medicine Physician
MD-15277
HI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000286773
HMSA BILLING NUMBER
HI
05
00A1015480
CA
05
634825-02
HI
Enumeration date
06/13/2007
Last updated
02/28/2025
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