Provider Demographics
NPI:1518956465
Name:ALLGOOD, LEANN CARI (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:CARI
Last Name:ALLGOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:MANAGED CARE DEPT
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:9159 W THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4910
Practice Address - Country:US
Practice Address - Phone:623-815-3380
Practice Address - Fax:623-815-3381
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086244208600000X
AZ40451208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7383733OtherCONFINITY
AZ2Z9023OtherHEALTH NET
AZ7383733OtherAETNA
AZP00784377OtherRAILROAD MEDICARE
AZ777911OtherWELLCARE MEDICARE ADVANTAGE
AZ387350Medicaid
AZ7383733OtherAETNA
AZ7383733OtherCONFINITY
AZ387350Medicaid