Provider Demographics
NPI:1003854514
Name:P DAVID DELEEUW, MD, PA
Entity Type:Organization
Organization Name:P DAVID DELEEUW, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:P.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:DELEEUW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-589-4909
Mailing Address - Street 1:PO BOX 111600
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-0127
Mailing Address - Country:US
Mailing Address - Phone:239-489-4909
Mailing Address - Fax:239-489-3901
Practice Address - Street 1:8350 RIVERWALK PARK BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8759
Practice Address - Country:US
Practice Address - Phone:239-489-4909
Practice Address - Fax:239-489-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27667207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95628Medicare ID - Type Unspecified