Provider Demographics
NPI:1649259623
Name:LEEDY, DORIS MARGARITA (MD)
Entity type:Individual
Prefix:DR
First Name:DORIS
Middle Name:MARGARITA
Last Name:LEEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-1137
Mailing Address - Country:US
Mailing Address - Phone:321-952-9696
Mailing Address - Fax:321-952-7937
Practice Address - Street 1:5270 BABCOCK ST NE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-4616
Practice Address - Country:US
Practice Address - Phone:321-676-5996
Practice Address - Fax:321-676-5926
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63747208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372797100Medicaid
FL593520087OtherHEALTH FIRST
FL18683OtherBLUE CROSS BLUE SHEILD
FL3736201002OtherCIGNA
FL593520087OtherUNITEDHEALTHCARE
FL632833OtherAETNA
FL593520087OtherHEALTH FIRST
FL593520087OtherHEALTH FIRST