Provider Demographics
NPI:1336254697
Name:TANANIS, LEONARD JOHN JR (MD)
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:JOHN
Last Name:TANANIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:507 N LINDSAY ST
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-4303
Mailing Address - Country:US
Mailing Address - Phone:336-883-0029
Mailing Address - Fax:336-883-0867
Practice Address - Street 1:1580 SKEET CLUB RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9530
Practice Address - Country:US
Practice Address - Phone:368-883-0029
Practice Address - Fax:368-830-8673
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9501124208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891197MMedicaid
G32607Medicare UPIN
NC891197MMedicaid