Healthcare Provider Details

I. General information

NPI: 1831167410
Provider Name (Legal Business Name): DAVID CHARLES LEECH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 10/15/2013
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:

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:
Title or Position:
Credential:
Phone: