Provider Demographics
NPI:1568700177
Name:SCOTT A LECKMAN MD FACS PC
Entity Type:Organization
Organization Name:SCOTT A LECKMAN MD FACS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:LECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-268-4924
Mailing Address - Street 1:1220 E 3900 S
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1377
Mailing Address - Country:US
Mailing Address - Phone:801-268-4924
Mailing Address - Fax:801-266-8809
Practice Address - Street 1:1220 E 3900 S
Practice Address - Street 2:SUITE 3G
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1377
Practice Address - Country:US
Practice Address - Phone:801-268-4924
Practice Address - Fax:801-266-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1725541205208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty