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NPI Code Detail

MEDICARE: LEASA A PRINCE MD

MEDICARE: LEASA A PRINCE MD
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
1207V00000XObstetrics & Gynecology PhysicianN8287AR

General Provider Information

NPI Number : 1689643405
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEASA A PRINCE MD
Provider Business Mailing Address
First Line : 521 MARSHALL RD
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-3749
Country : US
Telephone Number : 501-982-3461
Fax Number : 501-982-5640
Provider Business Practice Location Address
First Line : 521 MARSHALL RD
Second Line :
City : JACKSONVILLE
State : AR
Zip : 72076-3749
Country : US
Telephone Number : 501-982-3461
Fax Number : 501-982-5640
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2006
Last Update Date : 07/08/2007

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Directions to “ LEASA A PRINCE MD” Practice Location

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