Provider Demographics
NPI:1013273986
Name:BELMONTE, LEANDRA (DO)
Entity Type:Individual
Prefix:DR
First Name:LEANDRA
Middle Name:
Last Name:BELMONTE
Suffix:
Gender:F
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:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4017
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 304
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-202-3860
Practice Address - Fax:904-202-3846
Is Sole Proprietor?:No
Enumeration Date:2012-04-05
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA073975207R00000X, 208M00000X
FLOS13866207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03282308OtherAMERIGROUP
FLP01633800OtherRR MEDICARE
GAGA1790OtherSC MEDICAID
GAPAROtherPEACHSTATE
FL016956800Medicaid
GA003137652BMedicaid
GA1134444OtherWELLCARE
GA10000950962OtherBCBS GA
FLP01633800OtherRR MEDICARE
GAPAROtherPEACHSTATE
GA10293I1497Medicare PIN