Provider Demographics
NPI:1295833788
Name:LEACHMAN, SANCY A (MD)
Entity type:Individual
Prefix:DR
First Name:SANCY
Middle Name:A
Last Name:LEACHMAN
Suffix:
Gender:
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 841052
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-1052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:243 E 6100 S
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7302
Practice Address - Country:US
Practice Address - Phone:801-581-2955
Practice Address - Fax:801-581-4911
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD162207207N00000X
UT360389-1205207NP0225X
UT3603891205207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870468377001Medicaid
NV100506420Medicaid
ID806136501Medicaid
ID806136501Medicaid