Provider Demographics
NPI:1023120664
Name:URIBE, LEON CAMILO (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:CAMILO
Last Name:URIBE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 OKEECHOBEE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-4544
Mailing Address - Country:US
Mailing Address - Phone:561-420-8490
Mailing Address - Fax:561-420-8491
Practice Address - Street 1:5405 OKEECHOBEE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-4544
Practice Address - Country:US
Practice Address - Phone:561-420-8490
Practice Address - Fax:561-420-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08132800207QS0010X
TXM2164207QS0010X
PAMD430258207QS0010X
FLME100547207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine