Provider Demographics
NPI:1770500530
Name:LEON A DRISS MD PC
Entity Type:Organization
Organization Name:LEON A DRISS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-537-1077
Mailing Address - Street 1:5171 CUB LAKE RD
Mailing Address - Street 2:SUITE C380
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7888
Mailing Address - Country:US
Mailing Address - Phone:928-537-1077
Mailing Address - Fax:928-532-0757
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:SUITE C380
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-537-1077
Practice Address - Fax:928-532-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ76161Medicare PIN