Provider Demographics
NPI:1821343229
Name:LEONID B TROST MD LLC
Entity Type:Organization
Organization Name:LEONID B TROST MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:B
Authorized Official - Last Name:TROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-482-7546
Mailing Address - Street 1:9400 GLADIOLUS DR
Mailing Address - Street 2:STE 320
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-6699
Mailing Address - Country:US
Mailing Address - Phone:239-482-7546
Mailing Address - Fax:239-243-8648
Practice Address - Street 1:9400 GLADIOLUS DR
Practice Address - Street 2:STE 320
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-6699
Practice Address - Country:US
Practice Address - Phone:239-482-7546
Practice Address - Fax:239-243-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100046207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME100046OtherSTATE MEDICAL LICENSE