Provider Demographics
NPI:1215994025
Name:LEDER, LAURENCE SETH (DPM)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:SETH
Last Name:LEDER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8200 NW 27 ST
Mailing Address - Street 2:STE 108
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1906
Mailing Address - Country:US
Mailing Address - Phone:786-662-3893
Mailing Address - Fax:786-662-3899
Practice Address - Street 1:8600 SW 92ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7377
Practice Address - Country:US
Practice Address - Phone:305-595-3374
Practice Address - Fax:305-595-6615
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP0002658213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650967786OtherUNITED HEALTH CARE
FL340175800Medicaid
FL65645OtherBCBS
FL275268OtherAVMED
E2887Medicare PIN
FL275268OtherAVMED