Provider Demographics
NPI:1932452133
Name:LEONARD, ZACHARY RANDOLPH (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RANDOLPH
Last Name:LEONARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 COMMERCE CENTER CIR STE A
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-4500
Mailing Address - Country:US
Mailing Address - Phone:928-458-5723
Mailing Address - Fax:928-237-1787
Practice Address - Street 1:1947 COMMERCE CENTER CIR STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-4500
Practice Address - Country:US
Practice Address - Phone:928-458-5723
Practice Address - Fax:928-237-1787
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5202363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant