Provider Demographics
NPI:1316047582
Name:ALEXANDER, LEON G (MD)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:G
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3098 OAK GROVE RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8938
Mailing Address - Country:US
Mailing Address - Phone:704-582-1401
Mailing Address - Fax:704-588-2691
Practice Address - Street 1:17200 DUE WEST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28278-9003
Practice Address - Country:US
Practice Address - Phone:704-582-1401
Practice Address - Fax:704-588-2691
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2017-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC19007208G00000X
MOR3H78208G00000X
SC27660208G00000X
TXL2787208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2044133BMedicare ID - Type Unspecified
C52320Medicare UPIN