Provider Demographics
NPI:1841529591
Name:LEADER, JASON A (PA)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:LEADER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N FLAMINGO RD
Mailing Address - Street 2:SUITE 258
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1023
Mailing Address - Country:US
Mailing Address - Phone:954-430-2343
Mailing Address - Fax:954-438-2983
Practice Address - Street 1:603 N FLAMINGO RD
Practice Address - Street 2:SUITE 258
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1023
Practice Address - Country:US
Practice Address - Phone:954-430-2343
Practice Address - Fax:954-438-2983
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101468363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant