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General NPI Number Information
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NPI Number | 1427380708
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Entity Type | Organization
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Legal Business Name | IKER LEYCEGUI, M.D., P.A.
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Dates
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Enumeration Date | 02/11/2010
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Last Update Date | 02/11/2010
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Provider Practice Location Address
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Address Line | 145 CENTRAL PARK WEST SUITE 101
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34986
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Country | US
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Telephone | 772-873-1919
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 880472
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34988-0472
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, SOLE OWNER, PHYSICIAN
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Name | DR. IKER LEYCEGUI
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Credential | M.D.
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Telephone | 772-873-1919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME95881
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License Number State | FL
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