Healthcare Provider Details

I. General information

NPI: 1114133865
Provider Name (Legal Business Name): WILLIAM A. LEESON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 HOSPITAL DR STE D
SANTA FE NM
87505-4772
US

IV. Provider business mailing address

1630 HOSPITAL DR STE D
SANTA FE NM
87505-4772
US

V. Phone/Fax

Practice location:
  • Phone: 505-983-6774
  • Fax: 888-707-2979
Mailing address:
  • Phone: 505-983-6774
  • Fax: 888-707-2979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNM

VIII. Authorized Official

Name: DR. WILLIAM LEESON
Title or Position: DIRECTOR
Credential:
Phone: 505-983-6774