Provider Demographics
NPI:1477556728
Name:WALDENBERGER, LEONARD JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JAMES
Last Name:WALDENBERGER
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 1:2770 CAPITAL MEDICAL BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-8417
Mailing Address - Country:US
Mailing Address - Phone:850-878-8235
Mailing Address - Fax:850-219-2375
Practice Address - Street 1:2770 CAPITAL MEDICAL BLVD
Practice Address - Street 2:STE 200
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-8417
Practice Address - Country:US
Practice Address - Phone:850-878-8235
Practice Address - Fax:850-219-2375
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56839207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09721OtherINDIVIDUAL PROVIDER BCBS
FL99039OtherGROUP BCBS NUMBER
GA0051237719Medicaid
FL061917500Medicaid
FLP00625813OtherRR MEDICARE
GA0051237719Medicaid
GA0051237719Medicaid