Healthcare Provider Details

I. General information

NPI: 1821238171
Provider Name (Legal Business Name): ANN LEBECK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3353 CANYON DE FLORES SUITE A
SIERRA VISTA AZ
85650
US

IV. Provider business mailing address

3533 CANYON DE FLORES STE A
SIERRA VISTA AZ
85650-5366
US

V. Phone/Fax

Practice location:
  • Phone: 808-321-0567
  • Fax:
Mailing address:
  • Phone: 808-321-0567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number16920
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number57360
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number57.013093
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: