MEDICARE: DR. LEONARD FLORES POLANCO MD

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	208D00000X	General Practice Physician	39064	NC
2	207Q00000X	Family Medicine Physician	39064	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	2149574N	OTHER	NC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	68328	OTHER	NC	BLUE CROSS BLUE SHIELD OF
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811962954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD FLORES POLANCO MD

Provider Business Mailing Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-350-8039
Fax Number	:

Provider Business Practice Location Address
First Line	:	217 E ELM ST
Second Line	:
City	:	GRAHAM
State	:	NC
Zip	:	27253-3021
Country	:	US
Telephone Number	:	336-350-8039
Fax Number	:	336-350-8393

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	02/22/2021

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