Healthcare Provider Details

I. General information

NPI: 1336105758
Provider Name (Legal Business Name): KATHLEEN LEBER, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W DE LEON ST SUITE 201
TAMPA FL
33609-4168
US

IV. Provider business mailing address

2835 W DE LEON ST SUITE 201
TAMPA FL
33609-4168
US

V. Phone/Fax

Practice location:
  • Phone: 813-350-0700
  • Fax: 813-350-0703
Mailing address:
  • Phone: 813-350-0700
  • Fax: 813-350-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN LEBER
Title or Position: OWNER
Credential: M.D.
Phone: 813-350-0700