Healthcare Provider Details

I. General information

NPI: 1720158892
Provider Name (Legal Business Name): LEONARD J MCINTYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1440 S COUNTRY CLUB DR #12
MESA AZ
85210-9701
US

IV. Provider business mailing address

2700 N CENTRAL AVE 1050
PHOENIX AZ
85004-1133
US

V. Phone/Fax

Practice location:
  • Phone: 480-838-5550
  • Fax: 480-756-8201
Mailing address:
  • Phone: 602-266-8402
  • Fax: 602-264-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27994
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: