Provider Demographics
NPI:1487095980
Name:LEAMAN, JOSEPH HIRAM (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:HIRAM
Last Name:LEAMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14311 METROPOLIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4442
Mailing Address - Country:US
Mailing Address - Phone:239-768-0127
Mailing Address - Fax:239-768-0671
Practice Address - Street 1:14311 METROPOLIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4442
Practice Address - Country:US
Practice Address - Phone:239-768-0127
Practice Address - Fax:239-768-0671
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-12
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ006658207Q00000X
PAOT015416208600000X
FLOS14530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020920400Medicaid