Organization
DRS PAUL AND SHIRLEY LEADEM PA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL J LEADEM JR. M.D. (PRESIDENT)
(904) 829-6591
Entity
Organization
Contact information
Practice address
1740 TREE BOULEVARD, SUITE 112, ST AUGUSTINE, FL 32084-5774
(904) 829-6591
Mailing address
1740 TREE BLVD, SUITE 112, ST AUGUSTINE, FL 32084-5774
(904) 829-6591
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270529000
—
FL
01
—
4049277
AETNA GROUP NUMBER
FL
01
—
74622
BC/BS FLORIDA
FL
Enumeration date
11/01/2006
Last updated
04/14/2008
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