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NPI Code Detail

MEDICARE: ERNEST PAUL DE LEON MD

MEDICARE: ERNEST PAUL DE LEON MD
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
1207Q00000XFamily Medicine Physician0061518FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558454603
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERNEST PAUL DE LEON MD
Provider Business Mailing Address
First Line : 4225 NW AMERICAN LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-8841
Country : US
Telephone Number : 386-758-6141
Fax Number :
Provider Business Practice Location Address
First Line : 4225 NW AMERICAN LN
Second Line :
City : LAKE CITY
State : FL
Zip : 32055-8841
Country : US
Telephone Number : 386-758-6141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 02/10/2022

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