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General NPI Number Information
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NPI Number | 1285795815
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Entity Type | Organization
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Legal Business Name | INDEPENDENT ANESTHESIOLOGISTS OF KITSAP CO
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 2025 WHEATON WAY SUITE 102
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City | BREMERTON
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State | WA
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Zip | 98310-4300
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Country | US
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Telephone | 360-479-0809
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Fax | 360-377-3577
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Provider Business Mailing Address
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Address Line | 2025 WHEATON WAY SUITE 102
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City | BREMERTON
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State | WA
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Zip | 98310-4300
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Country | US
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Telephone | 360-479-0809
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Fax | 360-377-3577
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY PARK LEAKE
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Credential | MD
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Telephone | 360-479-0809
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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 | 601433588
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License Number State | WA
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