Healthcare Provider Details

I. General information

NPI: 1801885751
Provider Name (Legal Business Name): THOMAS J LESCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 NE 47TH ST SUITE 1
FT LAUDERDALE FL
33308-7711
US

IV. Provider business mailing address

1940 NE 47TH ST SUITE 1
FT LAUDERDALE FL
33308-7711
US

V. Phone/Fax

Practice location:
  • Phone: 954-772-4553
  • Fax: 954-771-2372
Mailing address:
  • Phone: 954-772-4553
  • Fax: 954-771-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME31566
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: