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General NPI Number Information
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NPI Number | 1619332814
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Entity Type | Organization
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Legal Business Name | KENT N LEIFER MD
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Dates
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Enumeration Date | 12/15/2015
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 375 S COURTENAY PKWY UNIT 4
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4886
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Country | US
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Telephone | 321-452-4730
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Fax | 321-453-6681
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Provider Business Mailing Address
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Address Line | 375 S COURTENAY PKWY UNIT 4
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City | MERRITT ISLAND
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State | FL
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Zip | 32952-4886
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Country | US
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Telephone | 321-452-4730
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Fax | 321-453-6681
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | KENT NELSON LEIFER
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Credential | M.D.
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Telephone | 321-452-4730
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207KA0200X
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Taxonomy Name | Allergy Physician
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License Number | ME24381
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License Number State | FL
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