Healthcare Provider Details

I. General information

NPI: 1578790093
Provider Name (Legal Business Name): LEON CAMILO URIBE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2009
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SEDONA WAY
PALM BEACH GARDENS FL
33418-1714
US

IV. Provider business mailing address

216 SEDONA WAY
PALM BEACH GARDENS FL
33418-1714
US

V. Phone/Fax

Practice location:
  • Phone: 561-779-0955
  • Fax: 561-622-1272
Mailing address:
  • Phone: 561-779-0955
  • Fax: 561-622-1272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD430258
License Number StateFL

VIII. Authorized Official

Name: LEON URIBE
Title or Position: PRESIDENT
Credential: MD
Phone: 561-779-0955