Individual
DR. KEVIN ANDREW LEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 634-2620
(573) 634-2033
Mailing address
1125 MADISON ST, JEFFERSON CITY, MO 65101-5227
(573) 634-2620
(573) 634-2033
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2012033009
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200015269
—
MO
Enumeration date
06/17/2011
Last updated
06/28/2022
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