Provider Demographics
NPI:1508907585
Name:LEAKE, ARTHUR ELDRIDGE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:ELDRIDGE
Last Name:LEAKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:ELDRIDGE
Other - Last Name:LEAKE
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:54 WESTALL AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3530
Mailing Address - Country:US
Mailing Address - Phone:828-258-1129
Mailing Address - Fax:
Practice Address - Street 1:54 WESTALL AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3530
Practice Address - Country:US
Practice Address - Phone:828-258-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15114207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951305Medicaid
NC208134AMedicare UPIN
NC8951305Medicaid