Provider Demographics
NPI:1831174333
Name:LEEMAN, EARL K (MD)
Entity type:Individual
Prefix:DR
First Name:EARL
Middle Name:K
Last Name:LEEMAN
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 1:217 W SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-3454
Mailing Address - Country:US
Mailing Address - Phone:801-628-3839
Mailing Address - Fax:
Practice Address - Street 1:217 W SUMMERHILL LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-3454
Practice Address - Country:US
Practice Address - Phone:801-628-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-07
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT142559-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870571510-03Medicaid
UT005551201Medicare ID - Type Unspecified
UTA02020Medicare UPIN