Provider Demographics
NPI:1841281060
Name:LEIPSIC, JOHN SYLVAIN JR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SYLVAIN
Last Name:LEIPSIC
Suffix:JR
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 1:2695 N CRAYCROFT ROAD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712
Mailing Address - Country:US
Mailing Address - Phone:520-322-2888
Mailing Address - Fax:
Practice Address - Street 1:2695 N CRAYCROFT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2243
Practice Address - Country:US
Practice Address - Phone:520-322-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG739632084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1859330OtherEDS PIN
CA00G739630Medicaid
CA00G739630Medicaid
CABL4342743OtherDEA NUMBER
CA00G739630Medicaid