Provider Demographics
NPI:1992700330
Name:PAULOS, LEON E (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:E
Last Name:PAULOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LONNIE
Other - Middle Name:E
Other - Last Name:PAULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:324 10TH AVE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2853
Mailing Address - Country:US
Mailing Address - Phone:801-408-8123
Mailing Address - Fax:801-408-8124
Practice Address - Street 1:324 10TH AVE
Practice Address - Street 2:SUITE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84103-2853
Practice Address - Country:US
Practice Address - Phone:801-408-8123
Practice Address - Fax:801-408-8124
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT157061-8905207XX0005X
NV5107207XX0005X
FLME102290207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL592-02754OtherBLUE CROSS BLUE SHIELD
FL53250OtherBLUE CROSS BLUE SHIELD
FL000725800Medicaid
UTD26530Medicare UPIN
FLBU989ZMedicare PIN
FL53250OtherBLUE CROSS BLUE SHIELD