Healthcare Provider Details

I. General information

NPI: 1184812018
Provider Name (Legal Business Name): DAVID B LEARY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 03/20/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MEDICAL GROUP, UNIT 5268 BLDG 626, KADENA AIR BASE
APO AP
96368-5268
US

IV. Provider business mailing address

DEPARTMENT OF THE AIR FORCE 18 OMRS/CC, UNIT 5268, BLDG 626, KADENA AB, JAPAN
APO AP
96368-5268
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number253314
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number253314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: