Provider Demographics
NPI:1588032676
Name:LEONARD, ALEXANDER GREGORY
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:GREGORY
Last Name:LEONARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 E UNIVERSITY BLVD # 20920
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-0521
Mailing Address - Country:US
Mailing Address - Phone:520-237-0992
Mailing Address - Fax:
Practice Address - Street 1:2750 S WOODLANDS VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-7128
Practice Address - Country:US
Practice Address - Phone:928-773-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-08
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZI011233390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program