MEDICARE: DR. CHARLES D LEONARD 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	207R00000X	Internal Medicine Physician	73-158	NM

General Provider Information

NPI Number	:	1871597849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES D LEONARD M.D.

Provider Business Mailing Address
First Line	:	12511 ELENA DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2221
Country	:	US
Telephone Number	:	505-823-9767
Fax Number	:

Provider Business Practice Location Address
First Line	:	12511 ELENA DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87122-2221
Country	:	US
Telephone Number	:	505-823-9767
Fax Number	:

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	07/08/2007

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