Healthcare Provider Details

I. General information

NPI: 1770724916
Provider Name (Legal Business Name): DAVID C LEECH DO INC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL LOOP NE SUITE 114
ALBUQUERQUE NM
87109-2129
US

IV. Provider business mailing address

101 HOSPITAL LOOP NE SUITE 114
ALBUQUERQUE NM
87109-2129
US

V. Phone/Fax

Practice location:
  • Phone: 505-888-7770
  • Fax: 505-830-0846
Mailing address:
  • Phone: 505-888-7770
  • Fax: 505-830-0846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA 830 86
License Number StateNM

VIII. Authorized Official

Name: DAVID CHARLES LEECH
Title or Position: OWNER
Credential: DO
Phone: 505-888-7770