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General NPI Number Information
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NPI Number | 1154416857
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Entity Type | Individual
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Provider Name | JASON E LEEDY MD
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 2060 LANDER RD
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City | MAYFIELD HEIGHTS
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State | OH
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Zip | 44124-4100
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Country | US
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Telephone | 440-461-6100
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Fax | 440-461-1440
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Provider Business Mailing Address
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Address Line | PO BOX 660
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City | MENTOR
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State | OH
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Zip | 44061-0660
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Country | US
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Telephone | 440-854-0217
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Fax | 440-461-1440
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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 | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 35085266
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License Number State | OH
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