MEDICARE: MONSOUR WEAVER LEB 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1720256126
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONSOUR WEAVER LEB PA

Provider Business Mailing Address
First Line	:	26 EMERALD CIR
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-4005
Country	:	US
Telephone Number	:	386-304-1212
Fax Number	:	386-304-8244

Provider Business Practice Location Address
First Line	:	1680 DUNLAWTON AVE
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4754
Country	:	US
Telephone Number	:	386-304-1212
Fax Number	:	386-304-8244

Authorized Official
Title or Position	:	SECRETARY/TREASURER
Name	:	DR. ROBERT B. LEB
Credential	:	M.D.
Telephone Number	:	386-304-1212

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/27/2008

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