MEDICARE: MARK C LEU PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA00722	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376538744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C LEU PA-C

Provider Business Mailing Address
First Line	:	1414 ARLINGTON ST
Second Line	:	SUITE 2300
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-332-0112
Fax Number	:	580-332-1005

Provider Business Practice Location Address
First Line	:	1414 ARLINGTON ST
Second Line	:	SUITE 2300
City	:	ADA
State	:	OK
Zip	:	74820-2643
Country	:	US
Telephone Number	:	580-332-0112
Fax Number	:	580-332-1005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2005
Last Update Date	:	08/11/2010

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Directions to “ MARK C LEU PA-C” Practice Location

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