Provider Demographics
NPI:1558776294
Name:LEONARD, JORDAN F (DO)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:F
Last Name:LEONARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JORDAN
Other - Middle Name:F
Other - Last Name:LEONARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:21 FOWLER FARM RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7558
Mailing Address - Country:US
Mailing Address - Phone:508-930-2843
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9496
Practice Address - Country:US
Practice Address - Phone:508-930-2843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3681207R00000X
2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine