MEDICARE: DR. LEON E PAULOS 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
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	157061-8905	UT
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	5107	NV
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	ME102290	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	592-02754	OTHER	AL	BLUE CROSS BLUE SHIELD
2	53250	OTHER	FL	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992700330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON E PAULOS MD

Provider Business Mailing Address
First Line	:	324 10TH AVE
Second Line	:	SUITE 175
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2853
Country	:	US
Telephone Number	:	801-408-8123
Fax Number	:	801-408-8124

Provider Business Practice Location Address
First Line	:	324 10TH AVE
Second Line	:	SUITE 175
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84103-2853
Country	:	US
Telephone Number	:	801-408-8123
Fax Number	:	801-408-8124

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	05/04/2012

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Directions to “ DR. LEON E PAULOS MD” Practice Location

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