Provider Demographics
NPI:1659378271
Name:LEONARD, LURALIE LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:LURALIE
Middle Name:LYNNE
Last Name:LEONARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3469 S CADMIUM LOOP
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85735-9003
Mailing Address - Country:US
Mailing Address - Phone:520-425-5240
Mailing Address - Fax:
Practice Address - Street 1:3469 S CADMIUM LOOP
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85735-9003
Practice Address - Country:US
Practice Address - Phone:520-425-5240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-29
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27818207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ824442Medicaid
AZAZ0740230OtherBCBS PIN
AZ51-0484039OtherTIN
AZ824442Medicaid
AZAZ0740230OtherBCBS PIN