Provider Demographics
NPI:1720158892
Name:MCINTYRE, LEONARD J (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 N CENTRAL AVE
Mailing Address - Street 2:1050
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1133
Mailing Address - Country:US
Mailing Address - Phone:602-266-8402
Mailing Address - Fax:602-264-0887
Practice Address - Street 1:1440 S COUNTRY CLUB DR
Practice Address - Street 2:#12
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-9701
Practice Address - Country:US
Practice Address - Phone:480-838-5550
Practice Address - Fax:480-756-8201
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ279942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ879455Medicaid
AZ879455Medicaid
AZ879455Medicaid