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General NPI Number Information
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NPI Number | 1033742283
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Entity Type | Organization
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Legal Business Name | DR. JOHN C. LEATHERMAN PLLC
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 400 WYANDOTTE PL
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City | RAMONA
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State | OK
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Zip | 74061-3678
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Country | US
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Telephone | 918-536-1024
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Fax | 918-536-4003
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Provider Business Mailing Address
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Address Line | PO BOX 420
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City | RAMONA
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State | OK
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Zip | 74061-0420
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Country | US
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Telephone | 918-536-1024
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Fax | 918-536-4003
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Authorized Official
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Title or Position | CEO
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Name | JOHN C LEATHERMAN
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Credential | MD
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Telephone | 918-876-2238
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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