Provider Demographics
NPI:1295028330
Name:LEATHEM, JAMES THOMAS (DO)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:LEATHEM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6247 E. MAIN STREET
Mailing Address - Street 2:SUITE 8
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-981-9151
Mailing Address - Fax:480-981-0527
Practice Address - Street 1:6247 E. MAIN STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-981-9151
Practice Address - Fax:480-981-0527
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2018-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ006657207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z177625Medicare PIN