Provider Demographics
NPI:1124085709
Name:LEONHEART, ERIC EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:EDWARD
Last Name:LEONHEART
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 SW 299TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-3572
Mailing Address - Country:US
Mailing Address - Phone:425-233-4597
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:9040 JACKSON AVENUE MADIGAN ARMY MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-5820
Practice Address - Country:US
Practice Address - Phone:253-968-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO-00000778213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1121714Medicaid
WAG8854560Medicare PIN
WA5447700001Medicare NSC
WAG8854559Medicare PIN
WAU48997Medicare UPIN
WAG8871711Medicare PIN