Provider Demographics
NPI:1205866381
Name:JOHN LEPORE DO PC
Entity Type:Organization
Organization Name:JOHN LEPORE DO PC
Other - Org Name:KIDFIXERS PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEPORE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:702-765-5437
Mailing Address - Street 1:10105 BANBURRY CROSS DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6646
Mailing Address - Country:US
Mailing Address - Phone:702-765-5437
Mailing Address - Fax:702-240-7268
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-765-5437
Practice Address - Fax:702-240-7268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV103429Medicare PIN