Provider Demographics
NPI:1841288446
Name:GRAS, LEONEL (PA)
Entity type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:GRAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4855 W HILLSBORO BLVD
Mailing Address - Street 2:STE B 2
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4356
Mailing Address - Country:US
Mailing Address - Phone:954-418-1683
Mailing Address - Fax:954-418-1698
Practice Address - Street 1:5355 LYONS RD
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2825
Practice Address - Country:US
Practice Address - Phone:954-570-9595
Practice Address - Fax:954-354-8151
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2015-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9102301363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292587700Medicaid
P90286Medicare UPIN
FL292587700Medicaid