Healthcare Provider Details

I. General information

NPI: 1043213291
Provider Name (Legal Business Name): LEON HENDLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEON HENDLEY MD

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 36TH STREET SUITE C
VERO BEACH FL
32960
US

IV. Provider business mailing address

1300 36TH STREET SUITE C
VERO BEACH FL
32960
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-4911
  • Fax: 772-569-4583
Mailing address:
  • Phone: 772-770-4911
  • Fax: 772-569-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME0044169
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: