Provider Demographics
NPI:1962897066
Name:TOM K LEONARD MD PA
Entity type:Organization
Organization Name:TOM K LEONARD MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-501-4242
Mailing Address - Street 1:3665 EMBASSY CIR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1017
Mailing Address - Country:US
Mailing Address - Phone:727-501-4242
Mailing Address - Fax:
Practice Address - Street 1:404 S CHILDS ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5958
Practice Address - Country:US
Practice Address - Phone:352-323-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-06
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 73798207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
41607KMedicare UPIN