Provider Demographics
NPI:1770575920
Name:LEONARD, CLINTON J (MD)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:J
Last Name:LEONARD
Suffix:
Gender:M
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 756
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85299-0756
Mailing Address - Country:US
Mailing Address - Phone:480-355-8525
Mailing Address - Fax:480-355-3115
Practice Address - Street 1:3499 S MERCY RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-0437
Practice Address - Country:US
Practice Address - Phone:480-355-8525
Practice Address - Fax:480-355-3115
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33779207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ942145Medicaid
AZZ103953Medicare PIN
AZI33458Medicare UPIN