Provider Demographics
NPI:1821055948
Name:JONATHAN B. LESLIE, D.O.,P.A.
Entity Type:Organization
Organization Name:JONATHAN B. LESLIE, D.O.,P.A.
Other - Org Name:JONATHAN B. LESLIE, D.O,P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-932-0024
Mailing Address - Street 1:21110 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1252
Mailing Address - Country:US
Mailing Address - Phone:305-932-0024
Mailing Address - Fax:305-682-8430
Practice Address - Street 1:21110 BISCAYNE BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1252
Practice Address - Country:US
Practice Address - Phone:305-932-0024
Practice Address - Fax:305-682-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3804207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6898Medicare ID - Type UnspecifiedMEDICARE PROVIDER