Provider Demographics
NPI:1285637397
Name:DANTZLER, LEON E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:E
Last Name:DANTZLER
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 1:4501 WEAVERHALL DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2574
Mailing Address - Country:US
Mailing Address - Phone:910-309-1924
Mailing Address - Fax:
Practice Address - Street 1:101 ROBESON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5552
Practice Address - Country:US
Practice Address - Phone:910-609-1617
Practice Address - Fax:910-609-1618
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39256208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8926988Medicaid
NC8926988Medicaid
NCE51664Medicare UPIN