Individual
MARY LISA LEONARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
985 ROBERT BLVD, SUITE 101, SLIDELL, LA 70458-2063
(985) 690-8300
(985) 847-2310
Mailing address
985 ROBERT BLVD, SUITE101, SLIDELL, LA 70458-2063
(985) 690-8300
(985) 847-2310
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
09276R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1963046
—
LA
Enumeration date
08/29/2006
Last updated
04/30/2014
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