Provider Demographics
NPI:1255523296
Name:LEONE, DOUGLAS MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:LEONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 BUSINESS PARK DR STE C
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-7449
Mailing Address - Country:US
Mailing Address - Phone:417-336-0033
Mailing Address - Fax:855-710-6552
Practice Address - Street 1:110 BUSINESS PARK DR STE C
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-7449
Practice Address - Country:US
Practice Address - Phone:417-336-0033
Practice Address - Fax:309-452-3376
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI54438207N00000X
IL036.129240207N00000X, 207ND0101X
LA333863207N00000X
MO2022035062207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1255523296Medicaid
IL036129240Medicaid
IL036129240Medicaid