Provider Demographics
NPI:1356373435
Name:HALL, LEATON HARMON JR (MD)
Entity type:Individual
Prefix:DR
First Name:LEATON
Middle Name:HARMON
Last Name:HALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2001 MICCOSUKEE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5307
Mailing Address - Country:US
Mailing Address - Phone:850-878-5151
Mailing Address - Fax:850-878-6723
Practice Address - Street 1:2001 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5307
Practice Address - Country:US
Practice Address - Phone:850-878-5151
Practice Address - Fax:850-878-6723
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068344207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378713300Medicaid
FL27935Medicare ID - Type Unspecified
FLG15743Medicare UPIN
FL378713300Medicaid