Healthcare Provider Details

I. General information

NPI: 1952350720
Provider Name (Legal Business Name): LEON PAUL MEAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 GOODLETTE RD N SUITE 201
NAPLES FL
34102-5616
US

IV. Provider business mailing address

730 GOODLETTE RD N SUITE 201
NAPLES FL
34102-5616
US

V. Phone/Fax

Practice location:
  • Phone: 239-262-1119
  • Fax: 239-262-2657
Mailing address:
  • Phone: 239-262-1119
  • Fax: 239-262-2657

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME54962
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberME54962
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME54962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: