Provider Demographics
NPI:1750336111
Name:LEONI, RICARDO R (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:R
Last Name:LEONI
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 1:203 RUE LOUIS XIV
Mailing Address - Street 2:SUITE B
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-5736
Mailing Address - Country:US
Mailing Address - Phone:337-981-8294
Mailing Address - Fax:337-984-6583
Practice Address - Street 1:203 RUE LOUIS XIV
Practice Address - Street 2:SUITE B
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5736
Practice Address - Country:US
Practice Address - Phone:337-981-8294
Practice Address - Fax:337-984-6583
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA03273R207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1144657Medicaid
LA53367Medicare ID - Type Unspecified
LA1144657Medicaid