Provider Demographics
NPI:1316947922
Name:LEON, LAWRENCE M (MD)
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:M
Last Name:LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 W 4TH ST STE 8
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-655-1414
Mailing Address - Fax:605-655-1420
Practice Address - Street 1:1000 W 4TH ST STE 8
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3700
Practice Address - Country:US
Practice Address - Phone:605-655-1414
Practice Address - Fax:605-655-1420
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-338942085R0202X
SD39552085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS102788Medicare PIN