Provider Demographics
NPI:1245288760
Name:GAUM, LEONARD DAVID (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:DAVID
Last Name:GAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:607 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8222
Mailing Address - Country:US
Mailing Address - Phone:314-251-8850
Mailing Address - Fax:314-569-3846
Practice Address - Street 1:607 S NEW BALLAS RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8222
Practice Address - Country:US
Practice Address - Phone:314-251-8850
Practice Address - Fax:314-569-3846
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR4A96208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201244514Medicaid
MO1245288760Medicaid
MOP01201857OtherRAILROAD MEDICARE
MO201244514Medicaid
MO148320001Medicare PIN
MO1245288760Medicaid