Provider Demographics
NPI:1720102593
Name:LURIA, LEONARD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:WILLIAM
Last Name:LURIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-875-6376
Mailing Address - Fax:813-878-2437
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-875-6376
Practice Address - Fax:813-878-2437
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 39830208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD85543Medicare UPIN