Provider Demographics
NPI:1790876811
Name:GRIGORYEV, LEON M (MD)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:M
Last Name:GRIGORYEV
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1 LAYFAIR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9717
Mailing Address - Country:US
Mailing Address - Phone:601-936-8801
Mailing Address - Fax:601-936-8808
Practice Address - Street 1:1 LAYFAIR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9717
Practice Address - Country:US
Practice Address - Phone:601-936-8801
Practice Address - Fax:601-936-8808
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS20728208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS407739OtherWINDSOR MEDICARE
MS407739OtherWINDSOR MEDICARE
MS302I253541Medicare PIN