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General NPI Number Information
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NPI Number | 1992700330
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Entity Type | Individual
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Provider Name | LEON E PAULOS MD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2005
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 324 10TH AVE SUITE 175
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-2853
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Country | US
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Telephone | 801-408-8123
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Fax | 801-408-8124
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Provider Business Mailing Address
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Address Line | 324 10TH AVE SUITE 175
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City | SALT LAKE CITY
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State | UT
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Zip | 84103-2853
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Country | US
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Telephone | 801-408-8123
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Fax | 801-408-8124
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 157061-8905
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 5107
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | ME102290
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License Number State | FL
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