Provider Demographics
NPI:1992948624
Name:FRANCE, LEROY VAUGHN (PA)
Entity type:Individual
Prefix:
First Name:LEROY
Middle Name:VAUGHN
Last Name:FRANCE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 LIVINGSTON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5023
Mailing Address - Country:US
Mailing Address - Phone:718-875-1144
Mailing Address - Fax:718-875-1002
Practice Address - Street 1:100 LIVINGSTON ST STE 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5023
Practice Address - Country:US
Practice Address - Phone:718-875-1144
Practice Address - Fax:718-875-1002
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0007731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant