Provider Demographics
NPI:1811962954
Name:POLANCO, LEONARD FLORES (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:FLORES
Last Name:POLANCO
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 1:217 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27253-3021
Mailing Address - Country:US
Mailing Address - Phone:336-350-8039
Mailing Address - Fax:
Practice Address - Street 1:217 E ELM ST
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:NC
Practice Address - Zip Code:27253-3021
Practice Address - Country:US
Practice Address - Phone:336-350-8039
Practice Address - Fax:336-350-8393
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39064208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68328OtherBLUE CROSS BLUE SHIELD OF
NC5900679Medicaid
NC2149574NOtherMEDICARE
NC5900679Medicaid