Provider Demographics
NPI:1962694562
Name:LEON-CONCEPCION, DORIS ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:ALEXANDRA
Last Name:LEON-CONCEPCION
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 TOWN CENTER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5873
Mailing Address - Country:US
Mailing Address - Phone:407-857-2817
Mailing Address - Fax:407-857-0234
Practice Address - Street 1:4170 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5873
Practice Address - Country:US
Practice Address - Phone:407-857-2817
Practice Address - Fax:407-857-0234
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 99471208000000X, 208D00000X
TXU3919208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208000000XAllopathic & Osteopathic PhysiciansPediatrics