Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 0103001046 | VA |
N | 213ES0103X | Foot & Ankle Surgery | 200007 | LA |
N | 213ES0103X | Foot & Ankle Surgery | SC002084L | PA |
NPI | 1033165642 |
---|---|
Provider Name | Leon G Shingledecker |
First Address | Alexandria, VA 22306-3403 |
Second Address | Alexandria, VA 22306-3403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9300619 | (05) | VA |