Individual
DR. PEDRO JOSUE DE LEON REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
619 S MARION AVE, LAKE CITY, FL 32025-5808
(386) 755-3016
Mailing address
619 S MARION AVE, LAKE CITY, FL 32025-5808
(386) 755-3016
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ACN518
FL
208D00000X
General Practice Physician
Primary
17332
PR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17332
STATE LICENSE
PR
Enumeration date
09/19/2008
Last updated
10/21/2014
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