Provider Demographics
NPI:1841527504
Name:LEO, CHADWICK (DO)
Entity type:Individual
Prefix:DR
First Name:CHADWICK
Middle Name:
Last Name:LEO
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-424-2060
Mailing Address - Fax:239-424-2061
Practice Address - Street 1:512 6TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-3558
Practice Address - Country:US
Practice Address - Phone:828-696-0897
Practice Address - Fax:828-692-2146
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-03313207V00000X
FLOS12755207V00000X, 207V00000X
PAOS015503207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016265300Medicaid