MEDICARE: DR. VINCENT DONALD LEPORE JR.

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	174400000X	Specialist	G048588	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	G048588	CA
3	208200000X	Plastic Surgery Physician	G048588	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	00G485880	OTHER	CA	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	770142258	OTHER	CA	TAX ID
2	770142558	OTHER	CA	GRP TAX ID
3	ZZZ15680Z	OTHER	CA	PTAN
4	G048588	OTHER	CA	CA LICENSE
6	1578689592	OTHER	CA	GRP NPI
7	ZZZ15681Z	OTHER	CA	BCBS
8	ZZZ15681Z	OTHER	CA	PTAN

General Provider Information

NPI Number	:	1356389241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT DONALD LEPORE JR.

Provider Business Mailing Address
First Line	:	2581 SAMARITAN DR
Second Line	:	SUITE 102
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4113
Country	:	US
Telephone Number	:	408-356-4241
Fax Number	:	408-356-4924

Provider Business Practice Location Address
First Line	:	2581 SAMARITAN DR
Second Line	:	SUITE 102
City	:	SAN JOSE
State	:	CA
Zip	:	95124-4113
Country	:	US
Telephone Number	:	408-356-4241
Fax Number	:	408-356-4924

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/30/2010

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Directions to “ DR. VINCENT DONALD LEPORE JR. ” Practice Location

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