Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101043356 | VA |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 0101043356 | VA |
NPI | 1013077148 |
---|---|
Provider Name | Dr. David Drake Leonard |
First Address | Fairfax, VA 22030-2434 |
Second Address | Fairfax, VA 22030-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 22/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D99090 | (02) | VA |