Provider Demographics
NPI:1457398851
Name:SEREBRO, LEONARD (MD FACT)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:SEREBRO
Suffix:
Gender:M
Credentials:MD FACT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5000 W ESPLANADE AVE
Mailing Address - Street 2:SUITE 247
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2551
Mailing Address - Country:US
Mailing Address - Phone:504-889-5242
Mailing Address - Fax:504-780-9251
Practice Address - Street 1:4315 HOUMA BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2940
Practice Address - Country:US
Practice Address - Phone:504-889-5242
Practice Address - Fax:504-780-9251
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2011-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA5142R207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5M106Medicare PIN
LAB61638Medicare UPIN