Provider Demographics
NPI:1558447847
Name:DOBERNE, LEONARD (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:DOBERNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LEN
Other - Middle Name:
Other - Last Name:DOBERNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2204 GRANT RD
Mailing Address - Street 2:#103
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-3855
Mailing Address - Country:US
Mailing Address - Phone:650-967-8841
Mailing Address - Fax:
Practice Address - Street 1:2204 GRANT RD
Practice Address - Street 2:#103
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-3855
Practice Address - Country:US
Practice Address - Phone:650-967-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36173207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G361730Medicaid
A46600Medicare UPIN
00G361730Medicare ID - Type Unspecified