Healthcare Provider Details

I. General information

NPI: 1881690923
Provider Name (Legal Business Name): LEON GARNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD EMERGENCY DEPARTMENT
POMPANO BEACH FL
33064-3502
US

IV. Provider business mailing address

3114 CROASDAILE DR SUITE 200
DURHAM NC
27705-2508
US

V. Phone/Fax

Practice location:
  • Phone: 919-425-1565
  • Fax: 919-425-0478
Mailing address:
  • Phone: 919-425-1565
  • Fax: 919-425-0478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS8407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: