Provider Demographics
NPI:1669408118
Name:LEAS, JOSEPH H (DPM)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:LEAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NE 87TH AVE
Mailing Address - Street 2:STE #2
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1930
Mailing Address - Country:US
Mailing Address - Phone:360-256-1777
Mailing Address - Fax:360-696-4287
Practice Address - Street 1:416 NE 87TH AVE
Practice Address - Street 2:STE #2
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1930
Practice Address - Country:US
Practice Address - Phone:360-256-1777
Practice Address - Fax:360-696-4287
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000402213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1109289Medicaid
WA1319750001Medicare NSC
WAT02586Medicare UPIN
WAAB17591Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID NU