MEDICARE: DORIS ALEXANDRA LEON-CONCEPCION 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	208000000X	Pediatrics Physician	ME 99471	FL
2	208D00000X	General Practice Physician	U3919	TX
3	208D00000X	General Practice Physician	ME 99471	FL

General Provider Information

NPI Number	:	1962694562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS ALEXANDRA LEON-CONCEPCION M.D.

Provider Business Mailing Address
First Line	:	4170 TOWN CENTER BLVD
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32837-5873
Country	:	US
Telephone Number	:	407-857-2817
Fax Number	:	407-857-0234

Provider Business Practice Location Address
First Line	:	4170 TOWN CENTER BLVD
Second Line	:	SUITE 102
City	:	ORLANDO
State	:	FL
Zip	:	32837-5873
Country	:	US
Telephone Number	:	407-857-2817
Fax Number	:	407-857-0234

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

Provider Enumeration Date	:	08/16/2007
Last Update Date	:	05/02/2023

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