Provider Demographics
NPI:1366638561
Name:PO, JOHN LEANDER (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN LEANDER
Middle Name:
Last Name:PO
Suffix:
Gender:M
Credentials:MD, PHD
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 245039
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5039
Mailing Address - Country:US
Mailing Address - Phone:520-626-6887
Mailing Address - Fax:520-626-5183
Practice Address - Street 1:3902 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2558
Practice Address - Country:US
Practice Address - Phone:520-468-4801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ37948207RI0200X, 207R00000X
MA218627207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z122161Medicare PIN