Provider Demographics
NPI:1063499572
Name:WHITSON, LELAND GILBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:GILBERT
Last Name:WHITSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1711 VIA EL PRADO
Mailing Address - Street 2:SUITE 201
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5714
Mailing Address - Country:US
Mailing Address - Phone:310-698-5252
Mailing Address - Fax:310-698-5777
Practice Address - Street 1:1711 VIA EL PRADO
Practice Address - Street 2:SUITE 201
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5714
Practice Address - Country:US
Practice Address - Phone:310-698-5252
Practice Address - Fax:310-698-5777
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-27
Last Update Date:2023-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA22527207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23123Medicare UPIN