Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 036101226 | IL |
N | 207VG0400X | Gynecologist | 036101226 | IL |
NPI | 1043216286 |
---|---|
Provider Name | Dr. John Henry Leno |
First Address | Davenport, IA 52801-1014 |
Second Address | Moline, IL 61265-1231 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 04/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036101226 | (05) | IL |
03732008 | BLUE CROSS BLUE SHIELD (01) | IL |
B54531 | (02) | IL |