Provider Demographics
NPI:1710176714
Name:PACE, LEONARD D (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:D
Last Name:PACE
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 1:3822 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FT. MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-8148
Mailing Address - Country:US
Mailing Address - Phone:239-274-3004
Mailing Address - Fax:
Practice Address - Street 1:189 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-3100
Practice Address - Country:US
Practice Address - Phone:954-316-2442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97929208VP0000X
FLME 97929207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD03969Medicare UPIN