Provider Demographics
NPI:1285078527
Name:MORAES, LEANDRO PETERSEN (MD)
Entity type:Individual
Prefix:DR
First Name:LEANDRO
Middle Name:PETERSEN
Last Name:MORAES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9567
Mailing Address - Fax:239-343-9571
Practice Address - Street 1:3501 HEALTH CENTER BLVD STE 1119
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:34135-8135
Practice Address - Country:US
Practice Address - Phone:239-343-9567
Practice Address - Fax:239-343-9571
Is Sole Proprietor?:No
Enumeration Date:2013-04-17
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101266765207RX0202X
FLME151070207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111609400Medicaid