Provider Demographics
NPI:1114983376
Name:CHOW, LEON C (MD)
Entity Type:Individual
Prefix:MR
First Name:LEON
Middle Name:C
Last Name:CHOW
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 1:1658 ST VINCENTS WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-8431
Mailing Address - Country:US
Mailing Address - Phone:904-276-5100
Mailing Address - Fax:904-276-5393
Practice Address - Street 1:1658 ST VINCENTS WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-8431
Practice Address - Country:US
Practice Address - Phone:904-276-5100
Practice Address - Fax:904-276-5393
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69843174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379297800Medicaid
FL28346YMedicare ID - Type Unspecified
FL379297800Medicaid