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NPI Code Detail

MEDICARE: LEON HERBERT OSMON M.D.

MEDICARE: LEON HERBERT OSMON 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
1207Q00000XFamily Medicine PhysicianME10332FL

General Provider Information

NPI Number : 1780693952
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEON HERBERT OSMON M.D.
Provider Business Mailing Address
First Line : 4643 VAN KLEECK DR
Second Line :
City : NEW SMYRNA BEACH
State : FL
Zip : 32169-4205
Country : US
Telephone Number : 386-423-0466
Fax Number :
Provider Business Practice Location Address
First Line : 1250 GRUMMAN PL STE B
Second Line :
City : TITUSVILLE
State : FL
Zip : 32780-7927
Country : US
Telephone Number : 321-269-4240
Fax Number : 321-269-5428
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2006
Last Update Date : 07/08/2007

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