MEDICARE: LEIGH RICHARDS BOECKLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1508136375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEIGH RICHARDS BOECKLE PA-C

Provider Business Mailing Address
First Line	:	2809 W CHARLESTON BLVD STE 150
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-1998
Country	:	US
Telephone Number	:	702-476-9999
Fax Number	:	702-946-1343

Provider Business Practice Location Address
First Line	:	6990 SMOKE RANCH RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-3119
Country	:	US
Telephone Number	:	702-476-9999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2012
Last Update Date	:	02/25/2022

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