Provider Demographics
NPI:1992016547
Name:DOUGLAS R LEDER DO PA
Entity Type:Organization
Organization Name:DOUGLAS R LEDER DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-686-2020
Mailing Address - Street 1:500 NORTHPOINT PKWY
Mailing Address - Street 2:#100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1903
Mailing Address - Country:US
Mailing Address - Phone:561-686-2020
Mailing Address - Fax:
Practice Address - Street 1:500 NORTHPOINT PKWY
Practice Address - Street 2:#100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1903
Practice Address - Country:US
Practice Address - Phone:561-686-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4720207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty