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General NPI Number Information
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NPI Number | 1588620447
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Entity Type | Individual
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Provider Name | WILLIAM A. LEESON M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 03/19/2022
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Provider Practice Location Address
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Address Line | 454 ST MICHAELS DR
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City | SANTA FE
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State | NM
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Zip | 87505-7602
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Country | US
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Telephone | 505-303-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 26666 PROVIDER ENROLLMENT
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City | ALBUQEURQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone | 505-923-6770
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Fax | 505-923-5354
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2005-0499
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License Number State | NM
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