MEDICARE: LEO C CHEN 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	207X00000X	Orthopaedic Surgery Physician	ME86347	FL
2	207X00000X	Orthopaedic Surgery Physician	K5484	TX
3	207X00000X	Orthopaedic Surgery Physician	054597	GA
4	207X00000X	Orthopaedic Surgery Physician	4940494-1205	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	57697	OTHER	FL	BCBS OF FLORIDA
2	2274459	OTHER		UNITED HEALTHCARE
3	7682478	OTHER		AETNA

General Provider Information

NPI Number	:	1326018391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO C CHEN M.D.

Provider Business Mailing Address
First Line	:	339 RACETRACK RD NW
Second Line	:	SUITE 12
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1538
Country	:	US
Telephone Number	:	850-864-3339
Fax Number	:	850-864-1715

Provider Business Practice Location Address
First Line	:	339 RACETRACK RD NW
Second Line	:	SUITE 12
City	:	FORT WALTON BEACH
State	:	FL
Zip	:	32547-1538
Country	:	US
Telephone Number	:	850-864-3339
Fax Number	:	850-864-1715

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	07/08/2007

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Directions to “ LEO C CHEN M.D.” Practice Location

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