Provider Demographics
NPI:1386745628
Name:LEEPER, NORMAN (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:LEEPER
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 1:1035 PORTER PIKE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-9581
Mailing Address - Country:US
Mailing Address - Phone:270-843-1199
Mailing Address - Fax:270-782-9996
Practice Address - Street 1:1035 PORTER PIKE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-9581
Practice Address - Country:US
Practice Address - Phone:270-843-1199
Practice Address - Fax:270-782-9996
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN303202084P0800X
KY417612084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100043320Medicaid
TN3831312Medicare ID - Type Unspecified
KY7100043320Medicaid