Provider Demographics
NPI:1689004855
Name:LEOS, SAMMY JOSEPH (PA-C, DSC)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:JOSEPH
Last Name:LEOS
Suffix:
Gender:M
Credentials:PA-C, DSC
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Other - First Name:
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Mailing Address - Street 1:673 MEDICAL GROUP
Mailing Address - Street 2:5955 ZEAMER AVE
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99506
Mailing Address - Country:US
Mailing Address - Phone:907-580-1243
Mailing Address - Fax:
Practice Address - Street 1:5955 ZEAMER AVE
Practice Address - Street 2:
Practice Address - City:ELMENDORF AFB
Practice Address - State:AK
Practice Address - Zip Code:99506-3702
Practice Address - Country:US
Practice Address - Phone:907-580-1243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2023-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMPA2014004363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical