Provider Demographics
NPI:1225589203
Name:WILLIAM A. LEESON, MD, PC
Entity Type:Organization
Organization Name:WILLIAM A. LEESON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-983-6774
Mailing Address - Street 1:1630 HOSPITAL DR
Mailing Address - Street 2:, SUITE D
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
Practice Address - Street 2:SUITE D
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:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service