Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 5657 | MD |
Y | 213EG0000X | General Practice | 5657 | MD |
NPI | 1003875881 |
---|---|
Provider Name | Dr. William Edward Leboe |
First Address | Baltimore, MD 21230-3910 |
Second Address | Baltimore, MD 21230-3910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T-59686 | (02) | MD |