Provider Demographics
NPI:1396718565
Name:LEDER, DOUGLAS R (DO)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:R
Last Name:LEDER
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:500 NORTHPOINT PKWY
Mailing Address - Street 2:#100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1903
Mailing Address - Country:US
Mailing Address - Phone:561-686-2020
Mailing Address - Fax:561-686-6204
Practice Address - Street 1:500 NORTHPOINT PKWY
Practice Address - Street 2:#100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-1903
Practice Address - Country:US
Practice Address - Phone:561-686-2020
Practice Address - Fax:561-686-6204
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS4720207W00000X
SC91293207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82754ZMedicare PIN
FL82754Medicare PIN