Healthcare Provider Details

I. General information

NPI: 1780666107
Provider Name (Legal Business Name): PAUL RICHARD LEASURE CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 STEWART WAY
MONROE OH
45050-1556
US

IV. Provider business mailing address

154 STEWART WAY
MONROE OH
45050-1556
US

V. Phone/Fax

Practice location:
  • Phone: 513-539-7000
  • Fax: 513-539-7005
Mailing address:
  • Phone: 513-539-7000
  • Fax: 513-539-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1210CSANSAASURG ASST
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: