Provider Demographics
NPI:1609899384
Name:BOK, LEONARD ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ROBERT
Last Name:BOK
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 1:330 JULIA ST PH 9
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-3661
Mailing Address - Country:US
Mailing Address - Phone:504-525-2005
Mailing Address - Fax:
Practice Address - Street 1:2020 GRAVIER ST RM 755
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2272
Practice Address - Country:US
Practice Address - Phone:504-568-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.11281R2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL79094Medicare ID - Type Unspecified
ILL79095Medicare ID - Type Unspecified
ILD95282Medicare UPIN