Organization
LEPORT SURGICAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER CARY LEPORT MD (PROVIDER/OWNER)
(714) 861-4666
Entity
Organization
Contact information
Practice address
18111 BROOKHURST ST, SUITE 5600, FOUNTAIN VALLEY, CA 92708-6728
(714) 861-4666
(714) 916-5534
Mailing address
18111 BROOKHURST ST, SUITE 5600, FOUNTAIN VALLEY, CA 92708-6728
(714) 861-4666
(714) 861-4682
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G47193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G471930
—
CA
Enumeration date
04/16/2007
Last updated
03/05/2012
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