MEDICARE: DR. DOUGLAS R LEDER D.O.

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	207W00000X	Ophthalmology Physician	OS4720	FL
2	207W00000X	Ophthalmology Physician	91293	SC

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	:	1396718565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS R LEDER D.O.

Provider Business Mailing Address
First Line	:	500 NORTHPOINT PKWY
Second Line	:	#100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1903
Country	:	US
Telephone Number	:	561-686-2020
Fax Number	:	561-686-6204

Provider Business Practice Location Address
First Line	:	500 NORTHPOINT PKWY
Second Line	:	#100
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33407-1903
Country	:	US
Telephone Number	:	561-686-2020
Fax Number	:	561-686-6204

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	04/05/2024

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