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General NPI Number Information
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NPI Number | 1285189290
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Entity Type | Organization
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Legal Business Name | JOHN C. LEACH, MD PLLC
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 08/19/2016
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Provider Practice Location Address
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Address Line | 75 WELLINGTON COLONY DR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2089
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Country | US
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Telephone | 501-326-3025
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Fax |
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Provider Business Mailing Address
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Address Line | 75 WELLINGTON COLONY DR
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2089
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Country | US
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Telephone | 501-326-3025
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN CLANTON LEACH
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Credential | M.D.
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Telephone | 501-326-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | E-9658
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License Number State | AR
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