Provider Demographics
NPI:1033290093
Name:LEONARD, JASON M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:LEONARD
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 1:325 BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-4167
Mailing Address - Country:US
Mailing Address - Phone:803-773-5227
Mailing Address - Fax:803-774-5400
Practice Address - Street 1:325 BROAD ST
Practice Address - Street 2:STE100
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4167
Practice Address - Country:US
Practice Address - Phone:803-773-5227
Practice Address - Fax:803-774-5400
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC272181Medicaid
SCP00473605OtherMEDICARE RR
SC272181Medicaid
SC7477Medicare PIN