Provider Demographics
NPI:1265435218
Name:LEEDS, CAREY (MD)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:LEEDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:REBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10097
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85130-0020
Mailing Address - Country:US
Mailing Address - Phone:520-836-3446
Mailing Address - Fax:520-836-8807
Practice Address - Street 1:803 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:WA
Practice Address - Zip Code:98944-2383
Practice Address - Country:US
Practice Address - Phone:509-837-1550
Practice Address - Fax:509-837-2066
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19977207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ031813OtherMEDICARE
AZ031820OtherMEDICARE
031881OtherMEDICARE
AZ031814OtherMEDICARE
ZFQ31815OtherMEDICARE
WAG8957356OtherWA MEDICARE
AZ031815OtherMEDICARE
ZFQ31815OtherMEDICARE