Individual
DR. DAVID BRYAN LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
2500 W A ST, SUITE 202, MOSCOW, ID 83843-6000
(208) 882-4662
(208) 883-6557
Mailing address
2500 W A ST, SUITE 202, MOSCOW, ID 83843-6000
(208) 882-4662
(208) 883-6557
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M8044
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805779000
—
ID
Enumeration date
12/06/2006
Last updated
03/03/2011
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