Provider Demographics
NPI:1891801767
Name:ERDMAN, LEONARD (MD)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:ERDMAN
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 1:1130 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2505
Mailing Address - Country:US
Mailing Address - Phone:954-563-3158
Mailing Address - Fax:954-563-5874
Practice Address - Street 1:1130 BAYVIEW DR
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2505
Practice Address - Country:US
Practice Address - Phone:954-563-3158
Practice Address - Fax:954-563-5874
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0006780207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD51493Medicare UPIN
FL06219SMedicare PIN