MEDICARE: LESLEE E BAUTE PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PAT9104766	FL
2	207N00000X	Dermatology Physician	PA9104766	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164672721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLEE E BAUTE PA

Provider Business Mailing Address
First Line	:	4002 SUN CITY CENTER BLVD
Second Line	:	UNIT 102
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5208
Country	:	US
Telephone Number	:	813-634-1455
Fax Number	:	813-642-8355

Provider Business Practice Location Address
First Line	:	4002 SUN CITY CENTER BLVD
Second Line	:	UNIT 102
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5208
Country	:	US
Telephone Number	:	813-634-1455
Fax Number	:	813-642-8355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	08/04/2010

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Directions to “ LESLEE E BAUTE PA” Practice Location

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