Provider Demographics
NPI:1285868281
Name:LEADBETTER, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:LEADBETTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3233 CENTRALIA ALPHA RD
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WA
Mailing Address - Zip Code:98570-9610
Mailing Address - Country:US
Mailing Address - Phone:360-867-4188
Mailing Address - Fax:360-867-0466
Practice Address - Street 1:3233 CENTRALIA ALPHA RD
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WA
Practice Address - Zip Code:98570-9610
Practice Address - Country:US
Practice Address - Phone:360-867-4188
Practice Address - Fax:360-867-0466
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028908207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery