Healthcare Provider Details

I. General information

NPI: 1326079682
Provider Name (Legal Business Name): LEONIDES Y. TEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

IV. Provider business mailing address

321 E ROBERTSON ST
BRANDON FL
33511-5253
US

V. Phone/Fax

Practice location:
  • Phone: 813-685-2191
  • Fax: 813-689-8755
Mailing address:
  • Phone: 813-685-2191
  • Fax: 813-689-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME0025284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: