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General NPI Number Information
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NPI Number | 1376538744
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Entity Type | Individual
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Provider Name | MARK C LEU PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 08/11/2010
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Provider Practice Location Address
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Address Line | 1414 ARLINGTON ST SUITE 2300
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City | ADA
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State | OK
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Zip | 74820-2643
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Country | US
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Telephone | 580-332-0112
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Fax | 580-332-1005
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Provider Business Mailing Address
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Address Line | 1414 ARLINGTON ST SUITE 2300
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City | ADA
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State | OK
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Zip | 74820-2643
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Country | US
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Telephone | 580-332-0112
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Fax | 580-332-1005
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00722
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License Number State | OK
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