Provider Demographics
NPI:1043213291
Name:HENDLEY, LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:HENDLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEON
Other - Middle Name:
Other - Last Name:HENDLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1300 36TH STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960
Mailing Address - Country:US
Mailing Address - Phone:772-770-4911
Mailing Address - Fax:772-569-4583
Practice Address - Street 1:1300 36TH STREET
Practice Address - Street 2:SUITE C
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960
Practice Address - Country:US
Practice Address - Phone:772-770-4911
Practice Address - Fax:772-569-4583
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044169207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
31164QMedicare PIN
FLD29730Medicare UPIN