Provider Demographics
NPI:1720171507
Name:LEUTE, ERIC JOHN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:LEUTE
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:PO BOX 459
Mailing Address - Street 2:PO
Mailing Address - City:IMPERIAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:91933-0459
Mailing Address - Country:US
Mailing Address - Phone:619-429-3733
Mailing Address - Fax:
Practice Address - Street 1:949 PALM AVENUE
Practice Address - Street 2:IMPERIAL BEACH HEALTH CENTER
Practice Address - City:IMPERIAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:91932
Practice Address - Country:US
Practice Address - Phone:619-429-3733
Practice Address - Fax:619-628-5550
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA80832AMedicare ID - Type Unspecified
I23341Medicare UPIN