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General NPI Number Information
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NPI Number | 1083610406
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Entity Type | Individual
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Provider Name | JEFFREY L LEACH CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 832 S MAIN ST
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City | ORRVILLE
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State | OH
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Zip | 44667-2208
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Country | US
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Telephone | 330-682-3010
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 MAYAPPLE DR
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City | HUDSON
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State | OH
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Zip | 44236-2452
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Country | US
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Telephone | 330-315-8398
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Fax |
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | RN-136249
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License Number State | OH
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