Provider Demographics
NPI:1932621257
Name:LEONARD, MARCUS VON (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:VON
Last Name:LEONARD
Suffix:
Gender:M
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11200 BROADWAY ST.
Mailing Address - Street 2:SUITE #1410
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:832-265-3766
Mailing Address - Fax:
Practice Address - Street 1:11200 BROADWAY ST.
Practice Address - Street 2:SUITE #1410
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:832-265-3766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2017-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management