Provider Demographics
NPI:1639831241
Name:LEOPARD, JOHN TYLER
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:TYLER
Last Name:LEOPARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 OWENBY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28270-5962
Mailing Address - Country:US
Mailing Address - Phone:704-644-9459
Mailing Address - Fax:
Practice Address - Street 1:6320 OWENBY CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28270-5962
Practice Address - Country:US
Practice Address - Phone:704-644-9459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant