Healthcare Provider Details

I. General information

NPI: 1871657692
Provider Name (Legal Business Name): BRIAN EDWARD LEDDEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

749 BUCKSAW DR
PENSACOLA FL
32506-9767
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-5638
  • Fax:
Mailing address:
  • Phone: 954-600-4758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberOS17777
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number02003129A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: