Provider Demographics
NPI:1184754400
Name:LEAKS, JOAN S (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:S
Last Name:LEAKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:151 W BROOKS AVE
Mailing Address - Street 2:501
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-3901
Mailing Address - Country:US
Mailing Address - Phone:702-399-6545
Mailing Address - Fax:702-642-1767
Practice Address - Street 1:151 W BROOKS AVE
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3901
Practice Address - Country:US
Practice Address - Phone:702-399-6545
Practice Address - Fax:702-642-1767
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV5178207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02641Medicare UPIN