Healthcare Provider Details

I. General information

NPI: 1003091372
Provider Name (Legal Business Name): WILLIAM C LEACH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2955 SE 3RD CT STE B
OCALA FL
34471-0441
US

IV. Provider business mailing address

PO BOX 4590
OCALA FL
34478-4590
US

V. Phone/Fax

Practice location:
  • Phone: 352-509-9900
  • Fax: 352-387-2584
Mailing address:
  • Phone: 352-509-9900
  • Fax: 352-387-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberME 0044750
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME44750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: