Provider Demographics
NPI:1891792305
Name:LEICHMAN, LAWRENCE PETER (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:PETER
Last Name:LEICHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 232410
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:858-249-6749
Mailing Address - Fax:
Practice Address - Street 1:1180 N INDIAN CANYON DR
Practice Address - Street 2:STE E218
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4885
Practice Address - Country:US
Practice Address - Phone:760-416-4860
Practice Address - Fax:760-416-4903
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42308207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C423080Medicaid
CA00C423080Medicaid
CA00C423081Medicare ID - Type Unspecified