Provider Demographics
NPI:1972221430
Name:JAMES LEO, M.D., PLLC
Entity Type:Organization
Organization Name:JAMES LEO, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DANA
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-463-6831
Mailing Address - Street 1:PO BOX 11689
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-1689
Mailing Address - Country:US
Mailing Address - Phone:928-463-6831
Mailing Address - Fax:
Practice Address - Street 1:804 AINSWORTH DR STE 105
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1624
Practice Address - Country:US
Practice Address - Phone:928-463-6831
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty