Provider Demographics
NPI:1184715658
Name:LEADEM, PAUL J JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:LEADEM
Suffix:JR
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 1:13241 BARTRAM PARK BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-5233
Mailing Address - Country:US
Mailing Address - Phone:904-829-6591
Mailing Address - Fax:904-824-8856
Practice Address - Street 1:13241 BARTRAM PARK BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-5233
Practice Address - Country:US
Practice Address - Phone:904-829-6591
Practice Address - Fax:904-824-8856
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77841208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267623100Medicaid
FL37711OtherBC/BS OF FLA
4049277OtherAETNA
4049277OtherAETNA