Provider Demographics
NPI:1740281377
Name:LEON, MARINO ENRIQUE (MD)
Entity type:Individual
Prefix:DR
First Name:MARINO
Middle Name:ENRIQUE
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1600 SW ARCHER RD
Mailing Address - Street 2:ANATOMIC PATHOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0275
Mailing Address - Country:US
Mailing Address - Phone:352-627-9260
Mailing Address - Fax:352-627-9242
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:ANATOMIC PATHOLOGY
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0275
Practice Address - Country:US
Practice Address - Phone:352-627-9260
Practice Address - Fax:352-627-9242
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2017-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD068252L207ZP0102X
FLME 96672207ZC0500X, 207ZP0102X
OH35.088499207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002446900Medicaid
FLDO979YMedicare PIN
PAH52173Medicare UPIN