Individual
JOHN LEWIS LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 5TH AVE STE 300, FORT WORTH, TX 76104-7303
(817) 250-6575
(817) 250-0109
Mailing address
PO BOX 5210, GRAND FORKS, ND 58206-5210
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
14199280-1206
UT
363AS0400X
Surgical Physician Assistant
PA19359
TX
Other
Enumeration date
08/10/2023
Last updated
04/20/2026
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