Provider Demographics
NPI:1831167410
Name:LEECH, DAVID CHARLES (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:LEECH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:101 HOSPITAL LOOP NE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-2129
Mailing Address - Country:US
Mailing Address - Phone:505-888-7770
Mailing Address - Fax:
Practice Address - Street 1:101 HOSPITAL LOOP NE
Practice Address - Street 2:SUITE 114
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2129
Practice Address - Country:US
Practice Address - Phone:505-888-7770
Practice Address - Fax:505-830-0846
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMA-830-86207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM40915Medicaid
NMC96744Medicare UPIN
NM$$$$$$$$$Medicare PIN