Healthcare Provider Details

I. General information

NPI: 1609899384
Provider Name (Legal Business Name): LEONARD ROBERT BOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GRAVIER ST RM 755
NEW ORLEANS LA
70112-2272
US

IV. Provider business mailing address

330 JULIA ST PH 9
NEW ORLEANS LA
70130-3661
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4646
  • Fax:
Mailing address:
  • Phone: 504-525-2005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD.11281R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.11281R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: