Provider Demographics
NPI:1144228388
Name:PYNES, LEONARD TERRY (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:TERRY
Last Name:PYNES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L
Other - Middle Name:TERRY
Other - Last Name:PYNES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2431 W MAIN ST
Mailing Address - Street 2:STE 501
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1274
Mailing Address - Country:US
Mailing Address - Phone:334-793-9222
Mailing Address - Fax:334-671-0322
Practice Address - Street 1:2431 W MAIN ST
Practice Address - Street 2:STE 501
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301
Practice Address - Country:US
Practice Address - Phone:334-793-9222
Practice Address - Fax:334-671-0322
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2024-04-12
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
AL8834207N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000081148Medicaid
AL000081148Medicare ID - Type Unspecified
ALC71888Medicare UPIN
AL000081148Medicaid