Provider Demographics
NPI:1134127376
Name:DUNN, LEONARD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JAY
Last Name:DUNN
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 1:601 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6612
Mailing Address - Country:US
Mailing Address - Phone:727-692-5023
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-5848
Practice Address - Country:US
Practice Address - Phone:727-692-5023
Practice Address - Fax:727-692-5023
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME23105207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036864400Medicaid
FL036864400Medicaid
FL62124WMedicare PIN