Healthcare Provider Details

I. General information

NPI: 1891792305
Provider Name (Legal Business Name): LAWRENCE PETER LEICHMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 N INDIAN CANYON DR STE E218
PALM SPRINGS CA
92262-4885
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 760-416-4860
  • Fax: 760-416-4903
Mailing address:
  • Phone: 858-249-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberC42308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: