Provider Demographics
NPI:1609220177
Name:MOURA LEITE, JOSE OYAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE OYAMA
Middle Name:
Last Name:MOURA LEITE
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 1:231 ALBERT SABIN WAY
Mailing Address - Street 2:ML 0558
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0558
Mailing Address - Country:US
Mailing Address - Phone:513-558-4748
Mailing Address - Fax:
Practice Address - Street 1:222 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-4231
Practice Address - Country:US
Practice Address - Phone:513-558-3700
Practice Address - Fax:513-558-5036
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1365462086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty