Provider Demographics
NPI:1245387737
Name:VIERON, LEONIDAS N (MD)
Entity Type:Individual
Prefix:
First Name:LEONIDAS
Middle Name:N
Last Name:VIERON
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:PO BOX 172339
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38187-2339
Mailing Address - Country:US
Mailing Address - Phone:901-844-1425
Mailing Address - Fax:901-844-1439
Practice Address - Street 1:2316 THORNWOOD LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-6722
Practice Address - Country:US
Practice Address - Phone:901-763-1695
Practice Address - Fax:901-682-3150
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-4704207R00000X
TN9440207R00000X
MS23420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN31726851Medicare PIN