Provider Demographics
NPI:1376954214
Name:JOSE M LEON MD
Entity Type:Organization
Organization Name:JOSE M LEON MD
Other - Org Name:JOSE M. LEON MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-974-4414
Mailing Address - Street 1:5640 W. ATLANTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:33063
Mailing Address - Country:UM
Mailing Address - Phone:954-974-4414
Mailing Address - Fax:954-975-7239
Practice Address - Street 1:5640 W. ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FLORIDA
Practice Address - Zip Code:33063
Practice Address - Country:UM
Practice Address - Phone:954-974-4414
Practice Address - Fax:954-975-7239
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSE M LEON MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0025157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty