Provider Demographics
NPI:1114976859
Name:LEONARD, EVELYN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ANN
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 1:801 20TH AVE E
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-4070
Mailing Address - Country:US
Mailing Address - Phone:205-384-0311
Mailing Address - Fax:
Practice Address - Street 1:801 20TH AVE E
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-4070
Practice Address - Country:US
Practice Address - Phone:205-384-0311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012740207Q00000X, 207V00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009917090Medicaid
AL009962675Medicaid
AL000046295Medicare ID - Type UnspecifiedMEDICARE NUMBER
AL009962675Medicaid