Basic Information
| Provider Information | |||||||||
| NPI: | 1386039519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEON | ||||||||
| FirstName: | AMIE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 W 8TH ST | ||||||||
| Address2: | BOX L-18 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043831003 | ||||||||
| FaxNumber: | 9042447388 | ||||||||
| Practice Location | |||||||||
| Address1: | 653 W 8TH ST | ||||||||
| Address2: | BOX L-18 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322096511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9043831003 | ||||||||
| FaxNumber: | 9042447388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2015 | ||||||||
| LastUpdateDate: | 10/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2085R0202X | UO4610 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.