Healthcare Provider Details

I. General information

NPI: 1336125004
Provider Name (Legal Business Name): MARK J LEDING D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N. STREET
CLINTON IA
52732
US

IV. Provider business mailing address

3400 DEXTER CT
DAVENPORT IA
52807-3461
US

V. Phone/Fax

Practice location:
  • Phone: 563-244-5555
  • Fax:
Mailing address:
  • Phone: 563-344-6667
  • Fax: 563-344-6740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2398
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036074323
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDO-02398
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: