Provider Demographics
NPI:1114133865
Name:WILLIAM A. LEESON, M.D., P.C.
Entity Type:Organization
Organization Name:WILLIAM A. LEESON, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LEESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-6774
Mailing Address - Street 1:1630 HOSPITAL DR STE D
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4772
Mailing Address - Country:US
Mailing Address - Phone:505-983-6774
Mailing Address - Fax:888-707-2979
Practice Address - Street 1:1630 HOSPITAL DR STE D
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4772
Practice Address - Country:US
Practice Address - Phone:505-983-6774
Practice Address - Fax:888-707-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521250Medicare PIN