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General NPI Number Information
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NPI Number | 1063505667
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Entity Type | Individual
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Provider Name | GLEN E LEER D.O.
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 204 W. MAIN STREET
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City | ARCADIA
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State | IN
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Zip | 46030
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Country | US
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Telephone | 317-984-8811
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Fax | 888-634-3182
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Provider Business Mailing Address
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Address Line | PO BOX 383
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City | ARCADIA
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State | IN
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Zip | 46030-0383
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Country | US
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Telephone | 317-984-8811
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Fax | 317-984-5862
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 02001252A
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License Number State | IN
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