Provider Demographics
NPI:1073694337
Name:LEON, RAMON (MD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:
Last Name:LEON
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 1:14750 NW 77TH CT
Mailing Address - Street 2:STE 100
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1507
Mailing Address - Country:US
Mailing Address - Phone:305-666-8691
Mailing Address - Fax:305-661-0905
Practice Address - Street 1:5901 SW 74TH ST STE 205
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5150
Practice Address - Country:US
Practice Address - Phone:305-666-8691
Practice Address - Fax:305-661-0905
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0092409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL33206OtherGROUP MEDICARE #
U5513ZMedicare ID - Type Unspecified
I38213Medicare UPIN