MEDICARE: DR. PAUL J. LEICHTER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	ME26539	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063497030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL J. LEICHTER M.D.

Provider Business Mailing Address
First Line	:	3920 BEE RIDGE RD
Second Line	:	BLDG B, SUITE B
City	:	SARASOTA
State	:	FL
Zip	:	34233-1207
Country	:	US
Telephone Number	:	941-921-5302
Fax Number	:	941-924-6987

Provider Business Practice Location Address
First Line	:	3920 BEE RIDGE RD
Second Line	:	BLDG B, SUITE B
City	:	SARASOTA
State	:	FL
Zip	:	34233-1207
Country	:	US
Telephone Number	:	941-921-5302
Fax Number	:	941-924-6987

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	05/30/2012

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