Provider Demographics
NPI:1285603365
Name:LEBER, KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:LEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2835 WEST DELEON STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-350-0700
Mailing Address - Fax:813-350-0703
Practice Address - Street 1:2835 WEST DELEON STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:813-350-0700
Practice Address - Fax:813-350-0703
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME80446207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL204098396OtherTAX ID
FLP00311628OtherMEDICARE RR
FL49391OtherBCBS
FL49391OtherBCBS
FLH28117Medicare UPIN