MEDICARE: LAWRENCE M LEON M.D.

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	2085R0202X	Diagnostic Radiology Physician	MD-33894	IA
2	2085R0202X	Diagnostic Radiology Physician	3955	SD

General Provider Information

NPI Number	:	1316947922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAWRENCE M LEON M.D.

Provider Business Mailing Address
First Line	:	1000 W 4TH ST STE 8
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078-3700
Country	:	US
Telephone Number	:	605-655-1414
Fax Number	:	605-655-1420

Provider Business Practice Location Address
First Line	:	1000 W 4TH ST STE 8
Second Line	:
City	:	YANKTON
State	:	SD
Zip	:	57078-3700
Country	:	US
Telephone Number	:	605-655-1414
Fax Number	:	605-655-1420

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/02/2018

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