Provider Demographics
NPI:1104932110
Name:MONROE, LESLIE DAVID (MD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:DAVID
Last Name:MONROE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:L
Other - Middle Name:DAVID
Other - Last Name:MONROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9250 GLADES RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-3958
Mailing Address - Country:US
Mailing Address - Phone:561-483-7707
Mailing Address - Fax:561-465-8282
Practice Address - Street 1:9250 GLADES RD STE 105
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-3958
Practice Address - Country:US
Practice Address - Phone:561-483-7707
Practice Address - Fax:561-465-8282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME33888207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL086555900Medicaid
FL93743Medicare ID - Type Unspecified
FLD62984Medicare UPIN
FL086555900Medicaid