Provider Demographics
NPI:1003091372
Name:LEACH, WILLIAM C (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:LEACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4590
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-4590
Mailing Address - Country:US
Mailing Address - Phone:352-509-9900
Mailing Address - Fax:352-387-2584
Practice Address - Street 1:2955 SE 3RD CT
Practice Address - Street 2:STE B
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0441
Practice Address - Country:US
Practice Address - Phone:352-509-9900
Practice Address - Fax:352-387-2584
Is Sole Proprietor?:No
Enumeration Date:2008-01-07
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0044750207QA0401X
FLME44750207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000216900Medicaid