Provider Demographics
NPI:1194829499
Name:ZARA, LEONARDO MONTUYA (MD)
Entity Type:Individual
Prefix:
First Name:LEONARDO
Middle Name:MONTUYA
Last Name:ZARA
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 1:201 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9479
Mailing Address - Country:US
Mailing Address - Phone:919-735-7580
Mailing Address - Fax:919-735-1475
Practice Address - Street 1:201 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9479
Practice Address - Country:US
Practice Address - Phone:919-735-7580
Practice Address - Fax:919-735-1475
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89128XEMedicaid
NC89128XEMedicaid
H34329Medicare UPIN