Healthcare Provider Details

I. General information

NPI: 1255938080
Provider Name (Legal Business Name): ERIC B LEEMAN PSR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY STE D
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax: 505-443-8335
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-443-8335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: