Provider Demographics
NPI:1821073719
Name:FICHTER, LEONARD ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:ANDREW
Last Name:FICHTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22207 FOX GLENN TRCE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32413-8413
Mailing Address - Country:US
Mailing Address - Phone:304-545-7444
Mailing Address - Fax:
Practice Address - Street 1:11501 HUTCHISON BLVD STE 109
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32407-3747
Practice Address - Country:US
Practice Address - Phone:850-250-1311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15559208600000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
328397OtherMAMSI
WV0124066000Medicaid
001710946OtherBCBS
WV020045263OtherMEDICARE RAILROAD
WV020045263OtherMEDICARE RAILROAD
B42694Medicare UPIN