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General NPI Number Information
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NPI Number | 1558510586
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Entity Type | Organization
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Legal Business Name | DIAGNOSTIC RADIOLOGY SERVICES, PROF, LLC
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 2212 VALLEY RD
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City | YANKTON
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State | SD
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Zip | 57078-1895
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Country | US
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Telephone | 605-689-1000
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Fax | 605-689-1001
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Provider Business Mailing Address
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Address Line | PO BOX 572
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City | YANKTON
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State | SD
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Zip | 57078-0572
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Country | US
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Telephone | 605-689-1000
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Fax | 605-689-1001
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE M LEON
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Credential | MD
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Telephone | 605-689-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 3955
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License Number State | SD
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